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Summer VBS Registration
Name of Child
Current School Grade
Parent/Guardian
Address
Cell Phone
Home Phone
Emergency Contact 1: Name
Emergency Contact 1 Phone
Emergency Contact 1 Relationship
Emergency Contact 2: Name
Emergency Contact 2 Phone
Emergency Contact 2 Relationship
The following individuals are authorized to pick up my child from VBS.
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Check or specify all allergies below
Specify any other allergies
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Do you allow Memorial Lutheran Church to take photos and post pictures of your child(ren) on social media?

Authorization of Treatment

Once you register, you will receive an email confirmation.

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