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Anchored VBS: Deepening Faith in God
Participant Registration Form (One Per Child)
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Monday June 7th to Thursday June 10th 6:00 to 8:00 PM
Child's Name
*
Your answer
Child's Age
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Grade Entering
*
3 to 4 years old
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
What days of VBS will you be attending?
Monday, June 7th
Tuesday, June 8th
Wednesday, June 9th
Thursday, June 10th
Name of Parent(s)
*
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Phone Number 1
*
Your answer
Phone Number 2
*
Your answer
Email Address
*
Your answer
Home Church
*
Your answer
Allergies or Other Medical Conditions
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
Emergency Contact- Relationship to Child
*
Your answer
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