Main Baptist Church
Vacation Bible School - 2019
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Name
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Age
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Grade Last Completed
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Address
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City
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Zip Code
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Home Phone
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Cell Phone
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Work Phone
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Email
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Home Church
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Parent/or Guardian Name
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Emergency Contact
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Emergency Contact Home Phone
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Emergency Contact Cell Phone
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Emergency Contact Work Phone
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Allergies or Other Medical Conditions
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Family Doctor
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List All Siblings Attending
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Who Will Drop Off?
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Telephone Number
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Who Will Pick Up?
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Telephone Number
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Do You Need Transportation?
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By signing this form, I hereby release any liability and waive all claims against Main Baptist Church, including any other persons or organization(s) with respect to participation in the programs and activities offered. I understand that my child’s participation in the activities provided by the church is my sole responsibility as parent or guardian. My signature below indicates that I understand and agree with this waiver in its entirety.
Electronic Signature Below
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