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Please submit one form per child
VBS 2015 Registration
Child's Last Name:
Child's First Name:
Child's Date Of Birth (mm/dd/yyyy):
Child's last school grade completed: (if applicable)
Any Special Medical Info: (Allergies, etc.)
Permission to Photograph:
Permission to Use Photograph in promotion of GracePointe:
Who May Pick Up Your Child?
Church that Your Family Attends:
How Did You Hear About Our VBS?
Emergency Contact Name and Phone Number: