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*Required information.
Child's Name *
Parent/Guardian Name(s): *
Address *
Phone Number (primary) *
Phone Number (secondary
Child’s School Grade (2021-2022 school year): *
Please list any medical information (especially allergies) we need to know
Please list any other information we need to know in order to serve your child well
Emergency Contact (name, relationship, phone number):
Please list the names of every person who is allowed to pick up your child after VBS each day
Please list the names of any of your child’s friends that are also registering for VBS at MCPC, if applicable
Please list your home church, if applicable
May we photograph your child
May we use photographs including your child for promotional purposes (e.g., on our website

To confirm that you are a person and not a machine filling out this form, please put the answer to the following math question into the space provided.