2018 Vacation Bible School Registration

 

 

 

AUGUST 6 - 10th, 9:00 - 12:00PM

 

 

 

Number of children you are registering
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Child Last Name*
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Child First Name*
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Birthday Month*
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Birthday Day*
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Birthday Year*
Enter year number

Grade Entering (Fall 2018)
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Does this child have any allergies? *
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Please check all that apply:
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Please be specific and give instructions:
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Does he/she carry an EPI Pen?
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Does he/she have a Bible?
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Child 2 First Name*
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Birthday Month*
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Birthday Day*
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Birthday Year*
Enter year number

Grade Entering (Fall 2018)
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Does this child have any allergies? *
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Please check all that apply:
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Please be specific and give instructions:
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Does he/she carry an EPI Pen?
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Does he/she have a Bible?
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Child 3 First Name*
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Birthday Month*
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Birthday Day*
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Birthday Year*
Enter year number

Grade Entering (Fall 2018)
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Does this child have any allergies? *
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Please check all that apply:
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Please be specific and give instructions:
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Does he/she carry an EPI Pen?
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Does he/she have a Bible?
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Child 4 First Name*
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Birthday Month*
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Birthday Day*
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Birthday Year*
Enter year number

Grade Entering (Fall 2018)
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Does this child have any allergies? *
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Please check all that apply:
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Please be specific and give instructions:
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Does he/she carry an EPI Pen?
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Does he/she have a Bible?
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Child 5 First Name*
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Birthday Month*
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Birthday Day*
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Birthday Year*
Enter year number

Grade Entering (Fall 2018)
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Does this child have any allergies? *
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Please check all that apply:
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Please be specific and give instructions:
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Does he/she carry an EPI Pen?
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Does he/she have a Bible?
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Child 6 First Name*
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Birthday Month*
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Birthday Day*
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Birthday Year*
Enter year number

Grade Entering (Fall 2018)
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Does this child have any allergies? *
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Please check all that apply:
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Please be specific and give instructions:
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Does he/she carry an EPI Pen?
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Does he/she have a Bible?
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Street Address*
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City*
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State*
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Zip*
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Email address
Please enter a valid email address

Father Last Name
Please let us know your name.

Father First Name
Please let us know your name.

Father Phone (where you can be reached during VBS)
Enter phone number: 123-456-7890

Mother Last Name
Please let us know your name.

Mother First Name
Please let us know your name.

Mother Phone (where you can be reached during VBS)
Enter phone number: 123-456-7890

Automated phone messages are occasionally sent out regarding this event (e.g., special theme days or weather concerns). Please enter the phone number you would like us to use.
Enter phone number: 123-456-7890

 

Please tell us who you would like us to call in the event of an emergency if one of the parents cannot be reached.

 

Emergency Contact
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Emergency Contact's Phone
Enter phone number: 123-456-7890

Emergency Contact's Relationship
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I hereby grant Mount Bethel Church the right to obtain and/or use my child's photograph, digitized image, video and/or voice recording for educational and informational purposes.*
You must authorize the media release form

Important note: We love adult volunteers but we first need you to complete the church volunteer application form!