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Vacation Bible School Fun!
Monday August 3rd - Friday August 7th
6:30pm - 8:30pm
Please call with any questions (717) 500-1102
Participant Info
First Name
Last Name
Participant Age
7
8
9
10
11
12
Parent / Guardian Info
First Name
Last Name
Parent / Guardian Email
Parent / Guardian Phone Number
Additional Emergency Contact Info
First Name
Last Name
Emergency Contact Email
Emergency Contact Phone Number
List any allergies or medical conditions
I consent to my child's receiving topical bug spray or cream
Yes
No
I consent to my child's participation in the VBS program.
Yes
No
I authorize the VBS staff to seek emergency medical treatment for my child if necessary.
Yes
No
By signing this form, I agree to release and hold harmless the VBS program, staff and volunteers from any claims or liability arising from my child's participation.
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