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2018 CPC VBS Registration | 2nd Grade
June 4th - 8th
Child's First Name *
Your answer
Child's Last Name *
Your answer
Gender *
Required
Date of Birth *
MM
/
DD
/
YYYY
Medical Conditions and/or Special Considerations
Please include any food allergies
Your answer
Street Address *
Your answer
Address Line 2
Your answer
City *
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State *
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Zip Code *
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Primary Parent/Guardian Contact
First Name *
Your answer
Last Name *
Your answer
Cell Phone Number *
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Work Phone Number
Your answer
Email Address *
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Alternate Emergency Contact
First & Last Name *
Your answer
Phone Number *
Your answer
May we have permission to photograph your child? *
May we have permission to use your child's photo in church publications and promotional materials? *
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