Magnified Vacation Bible School Registration
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First Name
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Last Name
*
Preferred Name
Date of Birth
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School Grade/Homeschool Grade
*
-- None --
Nursery/Pre-school
Kindergarten
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2
3
4
5
6
7
8
9
10
11
12
Gender
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Male
Female
Email Address
Phone Number
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Parent Name
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Parent Contact Information
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Parent Name
Parent Contact Information
Emergency Contact Name
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Emergency Contact Phone Number
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Mailing Address
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Mailing Address Line 2
Mailing City
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Mailing State
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Mailing Zip Code
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Please list any food allergies or severe environmental allergies
If your child has allergies, does your child use an epipen?
Does your child have asthma? If yes, please provide an inhaler/let us know of how to assist with any breathing difficulties.
Please list any special needs/developmental concerns. Please let us know of any activity restrictions.
Yes
No
Can we take photos of your child?
*
Yes
No
Do you regularly attend a church? If so, where do you attend?
Date of Salvation
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