Fairview Presbyterian Church VBS
July 28 - 31
5:30-8:00
CHILD'S LAST NAME: *
Your answer
CHILD’S FIRST NAME *
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GRADE COMPLETED AS OF JUNE 2019: *
CHILD'S AGE: *
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CHILD'S DATE OF BIRTH: *
MM
/
DD
/
YYYY
NAME(S) OF PARENT(S): *
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NAME(S) OF SIBLING(S) ALSO ATTENDING (each child still needs a registration form of their own): *
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STREET ADDRESS: *
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CITY: *
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STATE: *
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ZIP CODE: *
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TELEPHONE NUMBER: *
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PARENT EMAIL ADDRESS: *
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HOME CHURCH:
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ALLERGIES AND/OR MEDICATIONS NEEDED: *
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IN CASE OF EMERGENCY CONTACT: *
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RELATIONSHIP OF EMERGENCY CONTACT: *
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IN CASE OF EMERGENCY PHONE NUMBER: *
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