Thursday, October 19, 2017
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Student's Name:
 
Parent,Family, or Guardian Name:
 
Address:
 
City:   State:   Zip:
 
Phone Numbers: Home:   Cell:   Work:
 
Child's Date of Birth:   Child's Age:  
 
Last school grade completed:
 
Email:
 
Home Church:
 
Friends of your child at this church:
 
Allergies/Medical Information/Other: 
 
Emergency Contacts:
          Name:   Phone Number:
 
Name(s) of person(s) who may pick up this child from VBS:
 
If your child has special needs, please relevant information to office@silsbeeumc.com
 
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