Child's Full Name *

First Name

Last Name

Gender *

Female

Male

Phone 1 *

(###)

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Phone 2

If Applicable

(###)

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parents, please be aware that your child may be photographed during the week of VBS. Photos' will be used for Dunbar Heights Baptist Church's promotional purposes ONLY. Do you consent? *

Yes

No

Name

First Name

Last Name

Phone Number

(###)

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