Holiday Bible Club
August 23rd - 27th 2010
Registration Form
Child's Name
Month
Year
Day
Select
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2005
Birth Date
Select
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Select
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Address
Phone
Does your child take any medication or have any allergies? Please give details.
In case of emergency please provide details of someone who will be available during the Holiday Bible Club times.
Emergency Contact Name
Emergency Contact Number
We will be producing a DVD of the week for your child to take home.
If you DO NOT want your child to be photographed or filmed for the Holiday Bible Club DVD, please tick this box.
Your Name
Your Email