2019 VBS Registration Form for Levittown Church of God
Please fill out one per child.
Child's name *
Your answer
Child's gender *
Child's age *
Your answer
Date of birth *
Your answer
Last school grade completed *
Your answer
Name of parent(s)/guardian(s) *
Your answer
Street address, City, State, Zip *
Your answer
Cell phone number *
Your answer
Email address *
Your answer
Allergies or other medical conditions *
Your answer
In case of emergency, contact *
Your answer
Emergency contact phone number *
Your answer
Relationship to child *
Your answer
Additional Comments
Your answer
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