Vacation Bible School 2017 Registration
One Child per Registration Form
Child's First Name*
Child's Last Name*
Parent's First and Last Name*
Address (Street, City, and Zip)*
E-mail Address*
Phone Number*
Child's Date of Birth*
Child's Age*
Child's Last School Grade Completed*
Allergies/Medical Conditions/Other
Alternative Emergency Contact - Name and Phone Number*
Church Affiliation (optional)
T-Shirt Size for Child*


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