Summer Camp Detailed Registration Form

Vacation Bible School Registration

Victor Baptist Church - July 14-18
Child's Name *

First Name Last Name
Birth Date

Month Day Year
Grade *
Gender

Male Female

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Who will pick up your child? *
Parent/Guardian Information
Name *

First Name Last Name
Cell Number

Area Code Phone Number
Work Number

Area Code Phone Number
E-mail *
Emergency Information
Emergency Contact's Name

First Name Last Name
Relationship
Phone Number

Area Code Phone Number
Alt. Phone Number

Area Code Phone Number
Food Allergies?
Medical Concerns?
Should be Empty:

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