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ROAR Vacation Bible School Registration Form
Join us on an exciting adventure as we learn when life is wild, God is good! June 23-27 2019 (Sunday - Thursday)
Child's First Name *
Your answer
Child's Last Name *
Your answer
Name Tag Name *
Your answer
Parent/Guardian First and Last Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Child's Birthday *
MM
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DD
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YYYY
Home Phone
Your answer
Parent/Guardian Cell Phone *
Your answer
Email *
Your answer
Last Grade Completed at time of VBS in June 2019 *
Medical Information
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Emergency Contact Name #1 *
Your answer
Emergency Contact Number #1 *
Your answer
Emergency Contact Name #2
Your answer
Emergency Contact Number #2
Your answer
Authorized Person to Pickup #1 *
Your answer
Authorized Person to Pickup #1 (Phone Number) *
Your answer
Authorized Person to Pickup #2
Your answer
Authorized Person to Pickup #2 (Phone Number)
Your answer
Are you a member of Swift Creek Baptist Church
I currently attend church at:
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Photographs and Video will be taken during our event. Please let a Swift Creek children and youth committee member know if you have any questions or concerns.~pictures may be used in publications via the internet – however, names will not be used.~ Do you consent to having your child's picture taken during Vacation Bible School. *
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