Almont Vineyard Church
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Type your new text here.
First Name
Last Name
Email
Child #1 First Name
Child #1 Last Name
Child #1 Birthdate
Child #1 Please list any allergies, medical, or special needs
What grade has child #1 completed prior to the start of VBS?
Child #2 First Name
Child #2 Last Name
Child #2 Birthdate
Child #2 Please list any allergies, medical, or special needs
What grade has child #2 completed prior to the start of VBS?
Child #3 First Name
Child #3 Last Name
Child #3 Birthdate
Child #3 Please list any allergies, medical, or special needs
What grade has child #3 completed prior to the start of VBS?
Child #4 First Name
Child #4 Last Name
Child #4 Birthdate
Child #4 Please list any allergies, medical, or special needs
What grade has child #4 completed prior to the start of VBS?
Parent/Guardian's First Name
Parent/Guardian's Last Name
Phone Number
Email Address
Parent/Guardian's First Name
Parent/Guardian's Last Name
Phone Number
Email Address
Emergency Contact's First Name (if different from parent)
Emergency Contact's Last Name (if different from parent)
Phone Number
Email Address
Individual authorized to pick up my child's First Name
Individual authorized to pick up my child's Last Name
Relationship to Child
Individual authorized to pick up my child's First Name
Individual authorized to pick up my child's Last Name
Relationship to Child
Any additional comments or concerns
Submit