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* 1. Child’s name and age?

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* 2. Child’s name and age?

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* 3. Child’s name and age?

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* 4. Parent/guardian name

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* 5. Parent/Guardian Email Address

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* 6. What is your street address? City and Zip Code?

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* 7. Emergency Contact and Phone Number

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* 8. Food allergies? Other allergies?

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* 9. How did you hear about VBS?

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* 10. By entering your name in the box below, I give permission for my child to participate in the Faith Community Church VBS Program.  I release and discharge all liability for any harm or injury suffered directly or indirectly as a result of mychild's participation in the FCC VBS program, whether or not resulting from negligence, and I agree not to sue Faith Community Church, its representatives, staff or volunteers on any such claim. I also give permission for the staff, representative, or volunteers of Faith Community Church to administer first aid or to seek medical care for my child during my child's participation in the program, including transportation of my child to a medical facility for additional treatment that appears necessary. I also give permission for my child’s photo to be used on FCC social media and website.

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