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VBS Registration form
June 5-9 and graduation on June 10, 2023
6:00 pm to 8:30 pm
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* Indicates required question
Child’s name (First and Last name):
*
Your answer
Child’s nickname:
*
Your answer
Child’s age:
*
Your answer
Date of birth:
*
MM
/
DD
/
YYYY
Name of parents/guardians:
*
Your answer
Parent/guardian’s cell phone:
*
Your answer
Parent/guardian’s email address:
*
Your answer
Home address
*
Your answer
Custodial arrangement if applicable:
Your answer
Allergies or other medical conditions (i.e. diabetes):
*
Your answer
In case of emergency, contact (include name and phone number:
*
Your answer
I give permission to call 911 in case of an emergency.
*
Yes
No
Photographs will be taken during VBS. I am giving permission for my child’s photo to be taken.
*
Yes
No
Would you like to share any information regarding your child’s special needs? If you selected yes, a special needs survey form will be emailed to you.
yes
no
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