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JC Cowboy Church
Where Jesus Christ is KING!
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Registration Form
Child's Name
*
Grade in Fall
*
Age
*
Parent Name
*
Parent Name
Name of friends attending VBS:
Please list any special needs or physical limitations:
List any food allergies:
Please list the information of individuals who are authorized to pick up the child from VBS
Name
Phone
Street Address
Apartment, suite, etc
City
State/Province
ZIP / Postal Code
Prefix
Mr.
Mrs.
Ms.
Mx.
Miss
Dr.
Prof.
First Name
Last Name
Phone
Street Address
Apartment, suite, etc
City
State/Province
ZIP / Postal Code
Prefix
Mr.
Mrs.
Ms.
Mx.
Miss
Dr.
Prof.
First Name
Last Name
Phone
Street Address
Apartment, suite, etc
City
State/Province
ZIP / Postal Code
Who should we contact in case of emergency?
Prefix
Mr.
Mrs.
Ms.
Mx.
Miss
Dr.
Prof.
First Name
Last Name
Email Address
Phone
Street Address
Apartment, suite, etc
City
State/Province
ZIP / Postal Code
Prefix
Mr.
Mrs.
Ms.
Mx.
Miss
Dr.
Prof.
First Name
Last Name
Phone
Street Address
Apartment, suite, etc
City
State/Province
ZIP / Postal Code
Submit