Child's Name
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Grade Completed
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Age
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Parent/Guardian Name
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Contact Phone Number
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Address
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Emergency Contact
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Relation to Child
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Contact Phone Number
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Person(s) who may pick up this child from VBS each day other than Parent/Guardian
Name
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Relation to Child
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Name
Relation to Child
Medical Information/Special Needs (allergies, required medications, etc.)
Food Allergies/Dietary Needs:
Please indicate the number of family members who will attend the free celebration lunch (hot dogs) following VBS on Friday, August 2:
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I hereby give permission for the child listed above, to participate in all activities of First Christian Church's Vacation Bible School held at First Christian Church, 2035 Oleander Dr., Wilmington, NC 28403 on July 29 - August 2, 2013 from 8:45 am to 12:15 pm. I further give permission for medical treatment to be administered in the event of an emergency, understanding that every effort will be made to contact the person(s) listed above.
I will not hold First Christian Church, First Christian Church staff, or the volunteers teaching and helping liable for injury, trusting that the above mentioned event will be supervised in a responsible manner.
By entering your name you indicate that you have completed this form to the best of your knowledge and agree to the above paragraphs.
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Security Code
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