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Prayer Power VBS Registration
Monday, June 27 - Thursday, June 30
5:30 - 7:00 pm
*Meal provided each night from 5:30 - 6:00 pm for participants and volunteers.
Location:
Emanuel UCC
304 East Adams St.
Jackson, MO 63755
Contact:
Erica @ 270-2259
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* Indicates required question
Prayer Power VBS Registration (Child)
Student's Name
*
Your answer
Parent/Guardian Name
*
Your answer
I am . . . (select ALL THAT APPLY)
*
planning on staying with my child
willing to volunteer wherever needed
unable to volunteer
already planning on volunteering and have been in contact about it
Other:
Required
Address
Your answer
E-mail Address
Your answer
Phone
*
Your answer
Student's Age
*
Choose
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
11 years
12 years
Other
Last School Grade Completed
*
Choose
NONE: 3-4 years
Pre-K
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
6th Grade
Home Church (if applicable)
Your answer
Allergies/Medical Information/Other
*
Type "NA" if no concerns.
Your answer
Emergency Contact 1
*
Type Name and Number
Your answer
Emergency Contact 2
*
Type Name and Number
Your answer
Name(s) of person(s) who may pick up this child from VBS:
*
Mark "NA" if Adult
Your answer
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