VBS Pre-Registration 2019
Please fill out this form for your child for Vacation Bible School at Living Christ Church (151 South Broadway, Nyack, NY) from July 15-19, 2019, from 6:30-8:30 pm. If you have questions about this form, please contact the church office at 845-358-3125
Child's First and Last Name *
Your answer
Father/Guardian's First and Last Name
Your answer
Father/Guardian's Email
Your answer
Mother/Guardian's First and Last Name
Your answer
Mother/Guardian's Email
Your answer
Current Address (Street, City, State, Zip Code)
Your answer
Who has permission to pick up your children from VBS? *
Your answer
Emergency Contact (Name & Phone Number) *
Please provide the full name and best contact phone number for the individual(s) we will contact if there is an emergency.
Your answer
Child's Birthday *
MM
/
DD
/
YYYY
Child's Grade (in the fall)
Allergies *
Please specify allergies your child may have (including medications or food). If none, write "N/A"
Your answer
Is your child bringing any medication? *
Please list medication and use and/or dosage directions. If none, write "N/A"
Your answer
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