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Vacation Bible School 2018 - Camp Moose On the Loose - June 11-14, 2018

Child's Name *
Child's Name
Date of Birth (3 by 9/1/2017 - Completed 6th Grade) *
Date of Birth (3 by 9/1/2017 - Completed 6th Grade)
Parent/Guardian Name *
Parent/Guardian Name
Home Phone
Home Phone
Cell Phone *
Cell Phone
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Number *
Emergency Contact Number