CROSSPOINTE MEADOWS 2018 VBS REGISTRATION
Name: *
First and Last Name of Child
Your answer
Gender: *
Street Address: *
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City *
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State: *
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Zip Code *
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Home Phone: *
Your answer
Cell Phone: *
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Home E-mail address: *
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Age: *
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Date of Birth: *
Your answer
Last school grade completed: *
Your answer
School currently attending: *
Your answer
In case of emergency, contact: *
Your answer
Phone: *
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Mother:
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Father:
Your answer
Guardian:
Your answer
Preferred Shirt Size *
Siblings:
Your answer
Name of special friend that your child might like to be grouped with:
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Allergies or other Medical conditions:
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Special Needs your child might have:
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Church Home:
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Name(s) of adult your child can be released to: Valid Drivers License needed for release of children *
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I'm Paying... *
Payment is from:
Enter the name of the person making the payment
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