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818.242.2113
209 N. Louise Street
Glendale, California  91206-4296
VBS 2017 Registration Form
Student's Name:*
Parent/Family/Guardian Name:*
Address:*
Email Address:*
Phone Numbers
Home:*
Cell:*
Work:
Date of Birth:*
Age:*
Last school grade completed:*
Home Church:*
Friends of your child at this church:
Allergies/Medical Information/Other:*
Emergency Contacts
Name:*
Phone:*
Name:*
Phone:*
Dismissal Information
Name(s) of person(s) who may pick up this child from VBS:*
Other Information (church use only)
Hero Group:
Are parents/guardians/family members helping with VBS Hero Central?
If yes, where?
*** If your child has special needs, please also complete Special Needs Considerations form located on the side link under VBS ***


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