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Brookside Free Methodist Church
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BROOKSIDE FREE METHODIST CHURCH
2019 VBS JUNE 24 - 28
6:00 - 8:30
2019 VBS Registration Form
*
Indicates required field
Child's Name
*
First
Last
GENDER
*
MALE
FEMALE
Child's Birthday
*
Grade Last Completed
*
Medical / other information we need to know. Please include food allergies: (if none, please enter none)
*
Parent/Guardian Full Name
*
First
Last
[object Object]
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Email
*
Primary Phone Number
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Secondary Phone Number
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Alternate Phone Number
*
Home Church
*
Emergency Contact Person (Name)
*
First
Last
Primary Phone Number
*
Alternate Phone Number
*
In the event that I am unable to pick-up my child, the person named below has my permission to pick him/her up.
Is anyone else permitted to pick-up your child?
*
Yes
No
If yes, please enter name of person permitted.
*
First
Last
[object Object]
Name 2nd alternate person permitted
*
First
Last
1st
We take photos during the week of VBS, those pictures are posted on facebook. Also, we livestream the VBS program. We ask permission to use your child's picture for this purpose only. We will try to the best of our ability to comply with your wishes.
I give permission to have my child's picture published.
*
Yes
No
Your Signature is required (typing your name & submitting form constitutes your signature)
*
First
Last
[object Object]
Date
*
Submit