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Vacation Bible School Registration
Child's First Name *
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Child's Last Name *
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Boy or Girl? *

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Street Address *
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City *
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State *
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Zip Code *
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Home Phone *
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Please type phone numbers with only the 10 digits. No hyphens or parentheses.
Cell Phone
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For emergency contact only, 10 digits, no hyphens, no parentheses
E-mail Address *
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Email address confirmation *
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Please repeat your email address
Parent or Guardian Name *
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Emergency Contact Person *
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Emergency Contact Phone *
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Emergency Contact Relation to Child *
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Person Authorized to Pickup Child (other than yourself)
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Additional Person Authorized to Pickup Child
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Date of Birth in the format 11/24/2007 *
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Must be before 09/01/2013
Child is currently in what grade? *
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Allergies, medical conditions, behavioral challenges, or other info we should know about your child
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Name of one friend your child might like to be with
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This child should have your child's name on his/her registration form also. We will attempt to accommodate your request.
I have read the Liability Release and Photo Release and agree to its terms. *
Agreement with this release is required
Release can be found on Vacation Bible School web page at REGISTRATION INFORMATION, step 1
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Press "Submit". If you entered an email address and you do not get an email confirming your registration, please email vbs@deepruneast.org