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2019 VBS Nursery Needed
*
Indicates required field
Child's Name
*
First
Last
Child's Age
*
Potty Trained
*
Yes
No
Gender
*
Male
Female
Breast Feeding
*
Yes
No
Check the applicable catagory:
Mother's Name
*
First
Last
Phone Number
*
Father's Name
*
First
Last
Phone Number
*
Emergency Contact Name
*
First
Last
[object Object]
Relationship
*
Phone Number
*
The following information MUST BE COMPLETED to be accepted into the TN Assemblies of God Ministry Network Summer Camp Program at the Jackson Conference Center.
Is there any information we should have regarding the welfare of this attendee; handicaps, restrictions, diets, etc?
*
Yes
No
If yes, please provide:
*
List anything your child is allergic to:
*
AREA YOU ARE SERVING IN FOR VBS
*
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