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30
Questions
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1
First Child's Name
First Name
Last Name
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2
Which Session will your child be attending?
Only 50 participants per session available.
1:30pm-5:00pm
1:30pm-5:00pm
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3
What size shirt will your child need?
Shipwrecked VBS T-Shirt is included in the fee.
Youth X-Small
Youth Small
Youth Medium
Youth Large
Adult Small
Youth X-Small
Youth Small
Youth Medium
Youth Large
Adult Small
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4
Child's last school grade completed
Preschool
Kindergarten
First Grade
Second Grade
Thirds Grade
Fourth Grade
Preschool
Kindergarten
First Grade
Second Grade
Thirds Grade
Fourth Grade
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5
Medical or other information we may need to know about the child (including food allergies).
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6
Second Child's Name
First Name
Last Name
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7
Which Session will your child be attending?
Only 50 participants per session available.
1:30pm-5:00
1:30pm-5:00
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Submit
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8
What size shirt will your child need?
Shipwrecked VBS T-Shirt is included in the fee.
Youth X-Small
Youth Small
Youth Medium
Youth Large
Adult Small
Youth X-Small
Youth Small
Youth Medium
Youth Large
Adult Small
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9
Child's last school grade completed
Preschool
Kindergarten
First Grade
Second Grade
Thirds Grade
Fourth Grade
Preschool
Kindergarten
First Grade
Second Grade
Thirds Grade
Fourth Grade
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10
Medical or other information we may need to know about the child (including food allergies).
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Small
Ok
quote
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Ok
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11
Third Child's Name
First Name
Last Name
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12
Which Session will your child be attending?
Only 50 participants per session available.
1:30pm-5:00pm
1:30pm-5:00pm
Previous
Next
Submit
Press
Enter
13
What size shirt will your child need?
Shipwrecked VBS T-Shirt is included in the fee.
Youth X-Small
Youth Small
Youth Medium
Youth Large
Adult Small
Youth X-Small
Youth Small
Youth Medium
Youth Large
Adult Small
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14
Child's last school grade completed
Preschool
Kindergarten
First Grade
Second Grade
Thirds Grade
Fourth Grade
Preschool
Kindergarten
First Grade
Second Grade
Thirds Grade
Fourth Grade
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15
Medical or other information we may need to know about the child (including food allergies).
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Ok
quote
Created with Sketch.
Ok
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16
Parent/Legal Guardian Name
First Name
Last Name
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17
Parent Email
example@example.com
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18
Phone Number
Area Code
Phone Number
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19
Names of Persons to which the child (children) may be released to each day after VBS (Please provide at least two)
First Name
Last Name
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20
Full Name
First Name
Last Name
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21
Emergency Contact 1 (other than parent/guardian listed above)
First Name
Last Name
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22
Emergency Contact 1 Phone Number
Area Code
Phone Number
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23
Emergency Contact 2 (other than parent/guardian listed above)
First Name
Last Name
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24
Emergency Contact 2 Phone Number
Area Code
Phone Number
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25
By clicking the box below, I hereby give permission for photographs and/or video in which my child appears in to be used by the church in printed and/or electronic media, including the church's website.
I Agree
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26
Questions? Comment? Let us know
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27
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28
Will you be making an online payment?
You are welcome to pay in the church office. Payments must be made the week you register in order to hold your child's spot.
YES
NO
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29
Please select the VBS REGISTRATION line to make your payment and chose "One-time" donation under the frequency box. We will accept cash/check in the church office. PAYMENT MUST BE MADE THE WEEK YOU REGISTERED YOUR CHILD IN ORDER FOR YOUR CHILD'S SPOT TO BE HELD.
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30
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