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Middletown Church VBS 2023 Ready, Set, Move!
Register each child separately
Child Name
*
Child Date of Birth MM/DD/YY
*
Child Age
*
Please select
5
6
7
8
9
10
11
School
*
Grade Entering Fall 2023
*
Please select
K
1
2
3
4
5
Street Address
*
City
*
State
*
Zip Code
*
Home Phone #
*
Parent(s) Name(s)
*
Parent/Caregiver Cell #
*
Email Address
*
Home Church
Allergies or other medical conditions
Emergency Contact
*
Emergency Phone #
*
Relationship to Child
*
Name
First
Last
Name
First
Last
Name
First
Last
Name
First
Last
Name
First
Last
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