Higher Praise VBS
Rolling River Rampage Online Registration
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's Mailing Address
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Date of Birth *
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/
DD
/
YYYY
Student Age *
Your answer
Grade entering *
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Sex *
Allergies *
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Any other medical concerns?
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If you have a friend you would like to be grouped with please list below. We will do our best to honor these requests.
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Parent(s)/Guardian First Name *
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Parent(s)/Guardian Last Name *
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Parent(s)/Guardian Mailing Address *
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Parent(s)/Guardian Contact Phone Number *
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Parent(s)/Guardian Email address *
Your answer
Emergency Contact First and Last Name *
Your answer
Emergency Contact Phone number *
Your answer
Emergency Contact Relationship to Child *
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May your emergency Contact pick up your child ? *
Alternate pickup person first and last name
Your answer
Alternate pickup person phone number
Your answer
Alternate pickup person's relationship to child
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Parent(s)/Guardian comments
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Pictures may be taken of my child while participating in Higher Praise Church VBS activities, and may be used for program publicity. This may include future advertisement, internet postings, Facebook, Instagram, and Twitter. *
I understand that I (or a person I have approved) will be required to sign out my child from VBS each night. *
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