VBS Registration Form

VBS Registration Form

June 20-24, 2022 First Church DeLand 115 E Howry Ave

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Student Name *

First Name Last Name
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Age (Must be 4 by June 20) *
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Birth Date *

Month Day Year
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Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

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E-mail *
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Mobile Number *
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Phone Number
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Work Number
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In case of emergency, Contact      *
their name is   First Name*   Last Name*
at this phone number   Area Code*   Phone Number*

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Grade (Entering Fall 2022) *
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Name of Home Church *
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Known Allergies or Other Medical Conditions *
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Should be Empty: