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VBS Summer Day Camp Application

Child's First Namechild's first name
Child's Last Namechild last name
AddressAddress
Apartment NumberApartment
CityCity
StateState
Zip CodeZip
Date of BirthDate of Birth
The Grade they will be going to in September 2017grade
T-shirt size Adult or Childshirt
List all Allergiesallergies
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List all special needsneeds
0 /
Parent/Guardian First Nameguardian name
Parent/Guardian Last Nameguardian last
Cell PhoneCell
Home PhoneHome

Emergency Contact:

Name of a relative not residing with you.

Relative's First Namerelative first
Relative's Last Namerelative last
Relative's Phone Numberrelative phone
Relative's Relationship to Childrelative first
Individuals Who Have Permission to Pick up your Child
Name:permission1
Phone #permission2
Relationship to Childpermission3
Name:permission4
Phone #permission5
Relationship to Childpermission6
Name:permission7
Phone #permission8
Relationship to Childpermission9
Name:permission10
Phone #permission11
Relationship to Childpermission12
Name:permission13
Phone #permission14
Relationship to Childpermission15
Name:permission16
Phone #permission17
Relationship to Childpermission18
IF YOUR CHILD WILL NOT BE PICKED UP, DO THEY HAVE PERMISSION TO WALK ALONE?pick one!
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