Vacation Bible School Registration 2009
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West Side Church of Christ
Parent or Guardian Name: *
1st Child Name: *
1st Child Age: *
2nd Child Name:
2nd Child Age:
3rd Child Name:
3rd Child Age:
4th Child Name:
4th Child Age:
5th Child Name:
5th Child Age:
Address: *
City: *
State: *
Zip Code: *
Home Phone: *
Cell Phone:
E-mail Address: *
Enter E-mail if return confirmation is wanted and updates send.
Does any child have any food (dairy, peanut, etc.) allergy. *
Yes
No
If yes, please list: *
I hereby consent to our child(ern) participating in the West Side CofC VBS program *
I disagree
I agree