Lakeside PCA VBS: MISSION not IMPOSSIBLE 2017
VBS Dates: June19-23
Guardian Name (last, first)
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Address
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Contact Number
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Contact Email
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Child's Name
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Grade Completed
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Age
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Allergies and/or Medications
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T shirt size
Child's Name
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Grade Completed
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Age
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Allergies and/or Medications
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T shirt size
Child's Name
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Grade Completed
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Age
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Allergies and/or Medications
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T shirt size
Authorization: I the undersigned, agree and understand that Lakeside Presbyterian Church is not responsible for any accidents or injuries that my child/children may sustain arising out of their participation in VBS activities. I assume all risks associated with this activity and I, and anyone entitled to act on my behalf, release Lakeside Presbyterian Church from all claims whatsoever which may arise from this activity.
Please note that typing your name acts as your signature for the above statement
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