Full Name: *
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Street Address: *
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City, State, Zip: *
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Phone Number: *
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Secondary Phone Number:
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Email Address: *
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Emergency Contact Name: *
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Emergency Phone Number: *
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Church Affiliation:
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If adults other than yourself have permission to pick up your children from VBS, please list them here:
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How many children are you registering? *
All children must be 4 years old by July 14 and potty trained to attend.
Please contact us at vbsatcurc@gmail.com with any questions.
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