Registration Form: Deaf Vacation Bible School Silent Friends Chapel
June 27th-July 1st, 2022 | Contact Information:
Megan Luff
614-805-2213 (text)
Mluff@firstdallas.org
Warning!
This form cannot be submitted until an administrator completes the setup process to receive online payments.
Child's Name
*
Payment
$10
Child's Birth Date
*
What grade your child currently in?
*
Please select one option.
Kindergarten
First grade
Second Grade
Third Grade
Fourth Grade
Fifth h Grade
Sixth Grade
Allergies? If so, Please type below
*
Medical or other information we need to know.
*
Gender
*
Please select one option.
Boy
Girl
My Child is:
*
Please select one option.
Deaf
Hard of Hearing
Hearing
Who may pick up your child at the end of each VBS day?
*
Parents/Guardian information
Parents Name
*
Emergency Contact Name:
*
Main Phone to contact
*
Parents Email
*
This address will receive a confirmation email
Address
*
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May we have permission to use your child's photograph in church publication?
*
Please select all that apply.
Yes
No
Home Church:
*
If you are visiting our church, who are you a guest of?
Add another Child (siblings)
Child's Name
*
Childs Birth Date
My child is:
Please select one option.
Deaf
Hearing
Hard of Hearing
Gender
Please select one option.
Boy
Girl
Grade currently in:
Please select one option.
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Medical or other information we need to know.
Who may pick up your child at the end of each VBS day?
How did you hear about us?
*
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
June 27th-July 1st, 2022
Contact Information:
Megan Luff
614-805-2213 (text)
Mluff@firstdallas.org
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