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PAWLEYS ISLAND PRESBYTERIAN CHURCH VBS REGISTRATION
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* Indicates required question
FIRST AND LAST NAME
*
ENTER CHILD'S NAME
Your answer
CHILD'S AGE
*
Your answer
DATE OF BIRTH
*
MM
/
DD
/
YYYY
LAST SCHOOL GRADE COMPLETED
*
Your answer
NAME OF PARENT(S)
*
Your answer
STREET ADDRESS
*
Your answer
CITY
*
Your answer
STATE
*
Your answer
ZIPCODE
*
Your answer
HOME TELEPHONE
*
AREA CODE AND NUMBER
Your answer
PARENT/CAREGIVER'S CELL PHONE
*
Your answer
HOME EMAIL ADDRESS
*
Your answer
HOME CHURCH
Your answer
ALLERGIES OR OTHER MEDICAL CONDITIONS
Your answer
IN CASE OF EMERGENCY, CONTACT
*
PLEASE GIVE PHONE NUMBER (WITH AREA CODE) AND RELATION TO CHILD
Your answer
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