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Register Your Child
Parent First Name
Parent Last Name
Parent Phone Number
Email
Home Address
City
State
Zip Code
Emergency Contact: We will call this number if parent cannot be reached
Emergency Contact First Name
Emergency Contact Last Name
Phone Number
Permission to take Video/Photos of your child during VBS
Yes
No
Permission For Your Child To Walk Home
Yes
No
Do You Have A Home Church?
Child 1
First Name
Last Name
Grade In September
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Allergies
Child 2
First Name
Last Name
Grade In September
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Allergies
Child 3
First Name
Last Name
Grade In September
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Allergies
Child 4
First Name
Last Name
Grade in September
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Allergies
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