Liberty Baptist Church - Vacation Bible School Registration 2026

June 23- 26 | 6PM to 8PM | Please fill out this form and click submit.

Parent/Guardian Information

Parent/Guardian Full Name:

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Email

*

This address will receive a confirmation email

Phone

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Address

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Emergency Contact Name:

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Emergency Contact Phone number:

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Relationship to child:

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Child information:

Child full name:

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Preferred name/nickname:

Date of Birth:

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Age:

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Please select one option.

4 5 6 7 8 9 10 11 12

Known allergies (If none, put NA)

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Medical conditions or special needs: (If none, put NA)

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Does your child carry and EpiPen or an inhaler?

*

Please select one option.

Yes No Other

If you're registering additional children, please compelete a new form. Thank you!

Description

June 23- 26 | 6PM to 8PM

Please fill out this form and click submit.

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