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beech park baptist church

VBS Student Registration

Child First and Last Name

Parent/Guardian Name

Address (Street)

Address (City, Zip)

Parent Phone / Parent Email

Birthday / Last Grade Completed in School

Medical or other information we need to know. (Please include food allergies.)

Emergency Contacts (other than listed above)

Dismissal Information

I give permission to Beech Park Church to photograph or video my child for promotional purposes.

See you at VBS!

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