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VBS Registration 2017 Trinity Covenant Church July 10-14th 9 am - 12 pm
Email address
Child's First Name
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Child's Last Name
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Birth Date (mm/dd/yyyy)
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Grade Completed 2016-17
Select the grade that your child has completed this year. Trinity invites all children who Completed Kindergarten through Sixth Grade for the regular VBS program. If you are enrolling a 7th or 8th grade student, they will participate in the Junior High Program.
Known Allergies, Medical Conditions (asthma, etc)
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Parent/Guardian First Name
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Parent/Guardian Last Name
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Primary Phone Number
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Secondary Phone Number
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email address
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Mailing Address
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City
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State
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Zip Code
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Emergency Contact
In case of emergency, please enter the name of an individual we can contact if we are unable to contact you.
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Emergency Contact Phone Number
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Primary Care Physician (PCP)
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Primary Care Physician's Phone Number
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Medical Permission to Treat - e-signature with Parent/Guardian Name
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Permission to photograph
Photographs and videos will only be used exclusively for Trinity Covenant Church. I understand that my child's name will not be included with the photograph.
Church Affiliation?
Let us know what church you regularly attend. If you don't attend a church, we'd love to have you join us on Sunday!
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How did you hear about this VBS?
Please click on Submit when finished. If you have more children to register, please fill out a new registration form per child. You may email Michele Lane mlane786@gmail.com with any questions.
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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