VBS 2019 Registration Form
Lauderhill Seventh-day Adventist Church

Monday, June 24 – Friday, June 29
8:00 am – 2:00 pm
For ages 4–14
Child's Name (One form per child) *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Age *
Your answer
Grade Entering
Your answer
Parent/Guardian Name(s) *
Your answer
Child's Address - Line 1
Your answer
Child's Address - City
Your answer
Child's Address - State
Your answer
Child's Address - Zip
Your answer
Contact Phone Number (include area code) *
Your answer
Secondary Phone Number *
Your answer
Contact Email Address *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Name of person picking up child *
Your answer
How will your child go home (car, bus, walk, etc.)?
Your answer
Please list all allergies and/or medical concerns:
Your answer
How did you hear about VBS?
Your answer
Submit
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