June 21st - 25th
5:30-8:00 PM
* Child's Name
* Parent/Guardian Name
* Address
* Email Address
* Home Phone
Cell Phone
Work Phone
* Date of Birth (mm/dd/yyyy)
* Age
Last School Grade Completed Pre-K K 1 2 3 4 5
* Home Church
Allergies/Medical Info/Other
* Emergency Contact (1) Name
* Emergency Contact (1) Phone
* Emergency Contact (2) Name
* Emergency Contact (2) Phone
Dismissal Info - Name(s) of person(s) who may pick up child from VBS
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