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JAM Week Registration
After filling the details click on the SUBMIT button.

*indicates required fields 
  *Child's First Name:
  *Child's Last Name:
  *Parents' First & Last Name:
  *Date of Birth:
  *Grade Completed as of June 2017:  Preschool (ages 3 and up)
 Kindergarten
 First Grade
 Second Grade
 Third Grade
 Fourth Grade
 Fifth Grade
  Home Phone Number:
  *Cell Phone Number:
  *Email Address:
  *Gender:  Male
 Female
  *Allergy & Medical Information:
  *Street Address:
  *City:
  *Zip Code:
  *Emergency Contact (if parent is unreachable):
  *Emergency Contact phone number:
  *Emergency Contact relationship to child:
  Names of Others Authorized to pick your child up:
  Friend Request (limit one):
  *Does your child have any special needs?:  Yes
 No
  If so, please describe your child's strengths.:
  If so, please describe your child's needs.:
  If so, what strategies work best for your child?:
  My special needs child would do best at VBS:  In a regular 5 child crew, with a leader who is aware of his/her needs.
 In a regular 5 child crew, with a one-on-one adult buddy in addition to the regular leader
 In a self-contained classroom
 Other
  If you answered other, please explain:
  *Do you regularly attend worship service?:  Yes
 No
  If yes, where?:
  *How did you hear about our VBS?:
  *Preschool Parents: Choose a pick-up time:  7:30 p.m.
 8:30 p.m.
 Does Not Apply: I have an Elementary Student

After filling the details click on the SUBMIT button.
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