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Roar - VBS 2019 Preregistration Form
August 5-9, 2019 - Dinner at 5:30p - VBS from 6:00p-9:00p - Ages 3 through 6th Grade
*
Indicates required field
Parent/Guardian Name
*
First
Last
Home Church Affiliation
*
Phone Number
*
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Emergency Contact Name
*
First
Last
Emergency Contact Phone Number
*
Student 1 - Name
*
First
Last
Student 1 - Date of Birth
*
Student 1 - Grade in Fall (Select One)
*
Preschool
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Student 1 - Gender (Select One)
*
Male
Female
Allergies/Medical Concerns
*
Student 2 - Name
*
First
Last
Student 2 - Date of Birth
*
Student 2 - Grade in Fall (Select One)
*
Preschool
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Student 2 - Gender (Select One)
*
Male
Female
Allergies/Medical Concerns
*
Student 3 - Name
*
First
Last
Student 3 - Grade in Fall (Select One)
*
Preschool
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Student 3 - Date of Birth
*
Student 3 - Gender (Select One)
*
Male
Female
Allergies/Medical Concerns
*
Photo Release
Old Zion Wesleyan Church has my permission to use my or my child(ren)’s photograph publicly. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.
Photo Release Consent
*
I agree
I do not agree
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