Vacation Bible School Registration
Important Note:
Please scroll down to fill out the entire form then click submit
Child's Name
*
Birth Date
*
Grade Completed
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Parent Phone
*
Parent Cell Phone
Parent Email
*
This address will receive a confirmation email
Mother/Father (Name/Address if different from above
Emergency Contact
*
EMERGENCY CONTACT PHONE
*
I give permission for my child's/children's picture to be used for publicity purposes by St. Matthew or St. Johns
*
Please select all that apply.
Do Not
ALLERGIES OR OTHER CONDITIONS
ls there a person on site, that we could contact if needed ?
*
Church Affiliation
*
Would Appreciate Pastoral Contactl
*
Please select all that apply.
Yes
No
Submit
Description
Important Note:
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