VBS Child Registration 9 AM - Noon July 9-13, 2018 Ages 3 - completed 5th grade
Please fill out one form per child
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Child First Name *
Your answer
Child Last Name *
Your answer
Gender *
Last Grade Completed by 7/1/18 *
Date of Birth (Must be at least 3 by 8/30/18) *
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Address *
Your answer
City *
Your answer
State *
ZIP *
Your answer
Best Phone *
Your answer
Other Phone
Your answer
Parent/Guardian email *
Your answer
Home Church
Your answer
Allergies or other Medical Conditions *
Your answer
Emergency Contact
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Emergency Contact Phone
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Emergency Contact Relationship
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Comments
Your answer
You have my permission and consent for my child to attend VBS, to participate in its activities, to receive emergency treatment if necessary and to allow photographs, videos, and interviews to be taken and published and used to illustrate, promote, and advertise activities at Brunswick Church. I have read and understand these instructions. Signature Parent or Guardian *
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