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2025 Vacation Bible School
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/ 2025 VBS
VBS 2025
Child's First Name:
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Child's Last Name:
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Child's Age:
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Child's Date of Birth:
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Child's T-Shirt Size:
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Home Address:
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City:
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State:
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Zip:
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Parent/Guardian Name:
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Parent/Guardian Phone:
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Parent/Guardian Email:
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Does your child have any allergies (ex: food, environmental, pets, etc.)?
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Select an option
No
Yes
If yes, please specify:
Does your child have any special needs of which we should be made aware?
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Select an option
No
Yes
If yes, please specify:
Emergency Contact Name:
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Relationship to Child:
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Emergency Contact Phone:
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I grant permission for my child to attend St. Rafka Maronite Church Vacation Bible School. I am aware that in the event of an emergency, I will be contacted and expected to be available. If I am unavailable, my emergency contact person will be available. Overall, I am placing the well-being of my child in the care of the St. Michael VBS staff while he/she is attending the weeklong program. I trust the judgment of the staff when it comes to the health and safety of my child and will not hold St. Rafka VBS and its constituents liable.
Parent/Guardian Name:
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Parent/Guardian Digital Signature (Please type your full name):
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Date:
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