Newman UCC 2019 VBS- Shining Stars
VBS meets August 5-9 from 9am-12pm
Child's Full Name *
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Child's Preferred Nickname
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Date of Birth *
MM
/
DD
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YYYY
Age *
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Entering Grade in Fall 2019 *
Allergies/Medical Information/Special Concerns *
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Parent/Guardian Name *
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Address *
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Email *
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Home Phone *
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Cell/Work Phone *
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I can help on the following days
Emergency Contact in case Parent/Guardian can not be reached (Name & Phone Number) *
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Emergency Contact in case Parent/Guardian can not be reached (Name & Phone Number)
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The following have permission to pickup child from the program
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