2017 VBS Registration
Please fill out one per child
Name: (first and last)
Your answer
Age
Your answer
Street Address
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City:
Your answer
Home Phone:
Your answer
Cell Phone: (if available)
Your answer
Email Address:
Your answer
Date of birth:
MM
/
DD
/
YYYY
Last school grade completed:
Your answer
In case of emergency, contact: (please provide name and emergency contact number)
Your answer
Mother's/Guardians Name:
Your answer
Father's/Guardians Name:
Your answer
Allergies or other medical conditions (provide details if applicable)
Provide details of Allergies or other medical conditions if applicable
Your answer
Home Church
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Additional information about your child?
Your answer
Submit
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