Salem Missionary Baptist Church
Home
Fellowship
Harmony Cemetery and Union Baptist
VBS Pre-Registration form
Family Name
Child 1 Name
Child 1 Age
Child 2 Name
Child 2 Age
Parent Name
Street Address (Incl. Apt. No.)
City/State/Zip
Home Phone or Main Contact
Alternate Phone
Email Address
Is Parent dropping off/picking up?
Yes
No
If no, who is bringing child?
Phone of this person?
Emergency Contact Name
Emergency Contact Number
Food Allergies or Health Concerns
More Children Names and Ages
How did you hear about us?
Previous Attendance
Flyer
Friend
Newspaper
Other
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