The Reaction Lab VBS 2017
Child's Name (First and Last)
Your answer
Child's Age
Your answer
Child's Birthdate
MM
/
DD
/
YYYY
Child's last grade completed
Child's shirt size
Parent/Guardians Name
Your answer
Street Address
Your answer
City
Your answer
Zip Code
Your answer
Phone Number you can be reached during VBS times
Your answer
Email address
Your answer
MEDICAL INFORMATION: Medical or other information we need to know for each child (Please include any food allergies)
Your answer
Emergency Contact #1 (Please include name and phone number)
Your answer
Emergency Contact #2 (Please include name and phone number)
Your answer
Pick-up information: Who may pick up your child from VBS?
Your answer
Do you regularly attend church?
If so, where?
Your answer
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