Victory VBS 2021

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* 1. Name

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* 2. Date of Birth

Date / Time

Date

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* 3. Grade Completed

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* 4. Age

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* 5. Siblings Attending: Include name and ages

1st

2nd

3rd

4th

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* 6. General Info

Parent/Guardian

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 7. Emergency Contact Name and number

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* 8. Special needs/Allergies/Other concerns

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* 9. Is there a friend your child would like to be with?