2024 Vacation Bible School Registration Form Child's Name* First Last Birth Date* Month Day Year Child's gender* Male Female Grade (2024-2025 school year)* Parent Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent Phone*Alternate PhoneParent Email* Emergency Contact InformationEmergency Contact Name* First Last Relation to student* Emergency Contact Phone*Dismissal InformationPlease write the name and phone number of all who may pick up your child at the end of the day*Medical InformationPlease include any medical and/or food allergies*Other InformationMay we have permission to photograph your child?* Yes No May we have permission to use your child's photograph for the purpose of promotion?* Yes No Δ
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