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VBS Registration – June 10th-14th
Child's Name
*
First
Last
Gender
*
Male
Female
Age (3 and potty trained- entering 6th grade)
*
Grade Completed
*
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Medical Issues/ Allergies
Parent Name
*
First
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
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California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Maryland
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Northern Mariana Islands
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Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
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Washington
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Parent Email
*
Parent Cell Phone
*
Parent Home Phone
Home Church
*
Peace Lutheran
Trinity Lutheran
Other LCMS Lutheran
Other Lutheran in Faribault
Other Church in Faribault
Currently don't have a home church
Enter information for a second child if applicable
Child's Name
First
Last
Gender
Male
Female
Age (3 and potty trained-entering 6th grade)
Grade Completed
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Medical Issues/ Allergies
Enter information for a third child if applicable
Child's Name
First
Last
Gender
Male
Female
Age (3 and potty trained-entering 6th grade)
Grade Completed
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Medical Issues/ Allergies
May Peace Lutheran use photos or videos with the image of your child(ren) in a legal way for promotion and advertisement?
*
Yes
No
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