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VBS Registration Form



MEMBER   Yes     No

(Father) Last Name First Name
Will you be attending VBS?  Yes    No    
(Mother) Last Name First Name
Will you be attending VBS?  Yes     No    
Address
 
Home Phone Cell Phone
Email Address
CHILD INFO      
       
     May we have permission to photograph
    your child(ren)? Yes     No
May we have permission to use your child's photo for the purpose of promotion?
Yes     No
       
Enter information for each child below.
       
First Name Last Name
Age Grade Attending in Fall
***ALLERGIES
       
       
First Name Last Name
Age Grade Attending in Fall
***ALLERGIES
First Name Last Name
Age Grade Attending in Fall
***ALLERGIES
       
First Name Last Name
Age Grade Attending in Fall
***ALLERGIES
       
First Name Last Name
Age Grade Attending in Fall
***ALLERGIES
       
First Name Last Name
Age Grade Attending in Fall
***ALLERGIES
       
First Name Last Name
Age Grade Attending in Fall
***ALLERGIES
       
First Name Last Name
Age Grade Attending in Fall
***ALLERGIES
       
First Name Last Name
Age Grade Attending in Fall
***ALLERGIES
       
First Name Last Name
Age Grade Attending in Fall
***ALLERGIES
       
EMERGENCY CONTACT INFORMATION
Name Relationship
Contact Phone #    
       
       
       





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