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VBS Registration Form 2019 - CHILD
St. Timothy's Episcopal Church
Theme: Wizards and Wonders - A hero's Journey
JUNE 6-9, 5:30-7:15pm
Child's Name
*
First
Middle
Last
Child's Gender
*
Please select
Female
Male
Date of Birth
*
MM
/
DD
/
YYYY
Child's Age
*
Please select
4
5
6
7
8
9
10
Last school grade completed
*
Please select
Kindergarten
First
Second
Third
Fourth
Fifth
Name of Parent(s)
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Home Phone
###
-
###
-
####
Leave blank if none
Cell Phone
###
-
###
-
####
Leave blank if none
Email Address
Leave blank if none
Allergies or other medical conditions
Person Responsible for Picking up after VBS:
*
Do you agree to allow photos of your child to be used in church presentations or church promotional materials?
*
YES
NO
Home Church
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