2023 Vacation Bible School Registration
Parent / Guardian Name:
*
First Name
Last Name
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Parent / Guardian Email:
example@example.com
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Parent / Guardian Phone Number
*
Please enter a valid phone number.
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Child's Name:
*
First Name
Last Name
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Physical Address (Please no P.O Boxes):
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Child's age or recently completed grade in school:
*
Nursery-1st Grade
2nd grade-4th grade
5th grade-8th grade
High School
Please select any food allergies your child has:
*
No Known Allergies
Eggs
Milk/Diary
Peanuts/Peanut Butter
Shellfish
Soy
Tree Nuts
Wheat
Other
Please enter "Other Allergy" from above:
*
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Does your child have any medical condition(s) that we should be aware of?
*
Yes
No
Please enter any medical condition(s) if you answered yes to the question above:
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Emergency Contact Name:
*
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Emergency Contact Phone Number (If different from above):
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Can someone other than you pick up your child from VBS?
*
No
Yes
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Full name of other pickup (If yes, to question above, enter the full legal name of person):
*
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Please indicate the person's relationship to the child:
*
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May we have permission to photograph your child?
*
Yes
No
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If yes to the question above, may we have permission to post your child's picture on media?
*
Yes
No
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How did you hear about this year's Vacation Bible School?
Attended in a pervious year
Flyer
Social Media
Word of mouth
Submit
631 Kingston Rd, Lexington, KY, United States, Kentucky
(859) 293-1623
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