vbs2021signup

VBS 2021 REGISTRATION

JUNE 21st - 25th

Kernan Church
4000 Kernan Blvd S
jonathan@kernanchurch.com

Parent Details

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Child Details

Name *

First

Last

Grade (Finishing This Year) *

Date of Birth

Month *

Day *

Year *

Allergies / Special Needs *

Additional Contact Details

Emergency Phone #1 *

Emergency Phone #2 *

In addition to yourself, who is authorized to pick up your child?

Authorized Pick-Up #1 *

First

Last

Authorized Pick-Up #2 *

First

Last

Authorized Pick-Up #3 *

First

Last

Authorized Pick-Up #4 *

First

Last

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