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VBS Registration Form
Please fill out one per child attending Vacation Bible School at South Salem Church of the Nazarene
Child's Name *
Your answer
Gender *
Street Address *
Your answer
City
Your answer
State
Your answer
Zip *
Your answer
Telephone Number *
Your answer
Email *
Your answer
Last school grade completed *
Age *
Your answer
Name(s) of Parent/Guardian *
Your answer
Home Church
Your answer
Child's allergies to food or medicine: *
Your answer
Family Doctor *
Your answer
Doctor's phone number *
Your answer
Name of Insurance Provider *
Your answer
Insurance Policy Number & Group Number *
Your answer
Please list any behaviors that would be helpful for staff to know in working with your child during VBS
Your answer
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