Moravian Church of Lebanon
Est. Dec. 19, 1747
Name of sibling also attending VBS.
Second Parent's Name (optional)
Who else may pick up your child? (Give full name - not just "Grandma", "Neighbor", "Unlce" etc.) OPTIONAL, BUT WE WILL NOT ALLOW IF NAME IS NOT CLEARLY LISTED HERE.
Emergency Contact Phone #
Relationship to Child
Food Allergies? List, and describe reaction.
Other medical concerns
Name of home church, if applicable.
VBS leaders have permission to photograph/film the minor designated above in any manner or form for any LAWFUL purpose associated with this VBS program.
Parent/Guardian Signature (type legal name)
Thank you for contacting us. We are looking forward to seeing you at the Time Lab!!!
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