Christ Episcopal Church VBS Registration 2024

Vacation Bible School Registration Form
Institution Name
STUDENT INFORMATION
Name

First NameLast Name
M.I.
Birth Date *

MonthDayYear
Date
Grade completed by May 2024*
YesNo
If yes, what year?
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
EMERGENCY CONTACT
Primary Guardian*

First NameLast Name
Relationship to child*
Phone Number*
Medical Information
Please list all allergies -- or type "none" if there are none*
YesNo
Please list all medical concerns -- or type "none" if there are none*
Additional Information
YesNo
YesNo
By submitting this form, I ackowledge I have read and understand the above information.
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Vacation Bible School Registration Form