Vacation Bible School

Vacation Bible School Registration Form

Attendee Last Name(*)
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Attendee First Name(*)
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Street Address(*)
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City(*)
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State(*)
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Zip Code(*)
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Email(*)
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Cell Number(*)
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Home Phone Number(*)
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Work Number
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Are you a member of Mount Zion?(*)
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If not, are you a member of a church?(*)
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If yes, where?
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Do you have any food or drug allergies?(*)
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If yes, please explain and list.
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Do you have any special needs that we should be aware of?(*)
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If yes, please explain and list?
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Age or Grade Completed This Year

Age or Group Completed as of June 2018(*)
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The following person(s) are authorized to pick up my child:

Authorized Person Name and Number
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Authorized Person Name and Number
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Person Submitting Registration Form(*)
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