GRACE BAPTIST
August 5
th
- 9
th
Ages 5 - 16
6:15 - 8 PM
*
Indicates required field
Parent's Name
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Parent's Phone
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Child 1 Name
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Birthday
*
Age
*
Gender
*
Male
Female
Special Needs
*
Child 2 Name
*
Birthday
*
Age
*
Gender
*
Male
Female
Special Needs
*
Child 3 Name
*
Birthday
*
Age
*
Gender
*
Male
Female
Special Needs
*
Child 4 Name
*
Birthday
*
Age
*
Gender
*
Male
Female
Special Needs
*
Address
*
Email
*
City
*
State
*
Zip Code
*
Emergency Contact
*
Relationship
*
Phone Number
*
Please Select When You Agree:
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I am the parent or legal guardian of the child(ren) listed above.
I give my permission for my child(ren) to attend the VBS at Grace Baptist Church.
Comment or Special Instructions:
*
Submit
