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VBS Signup Form

Child's Name:

Age:           Birthdate (mm/dd/yyyy):          Grade Completed:
                

Parent's Name:

Address:

City:                                  State:              Zip:
         
Home Phone:                   Emergency Phone:
      

Food Allergies?   No   Yes

If Yes, Please Explain:


Any Medical Concerns that our VBS Staff needs to be aware of?     No   Yes

If Yes, Please Explain:



Siblings Attending VBS:

Church Affiliation:

Church Membership:


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