E-mail Address:
*
Child #1
*
Age
*
Street Address/City/Zip
*
Home Phone
Cell Phone
Date of Birth
*
Last Grade Completed (as of June 07)
In case of Emergency, contact
*
Mother
Father
Other
Allergies or Medical Conditions
Home Church
Name of Friend you might like to be with
Child #2
Age
Date of Birth
Last Grade Completed (as of June 07)
Allergies or Medical Conditions
Name of Friend you might like to be with
Child #3
Age
Date of Birth
Last Grade Completed (as of June 07)
Name of Friend you might like to be with
*
Required
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Vacation Bible School Registration
June 11-15, 2007
5:00pm - 8:15pm