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Madison Street United Methodist Church

319 Madison Street, Clarksville, Tennessee

VBS Enrollment Form
  1. VBS: June 2: 5-7pm, June 3: 10am-1pm, June 4: 9am-1pm

    If you'd like to sign up your child for Vacation Bible School (VBS), please provide the information requested below. When you select "Send" an email with your enrollment will be sent to Brooke at the church office.

    You'll need to complete a form for each child being enrolled. (*) indicates a required field - Thanks!

  2. First Name(*)
    Please let us know your name.
  3. Last Name(*)
    Please let us know your name.
  4. Gender(*)
    Invalid Input
  5. Parent's Name(*)
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  6. Parent Contact Number(*)
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  7. Address(*)
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  8. City(*)
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  9. State(*)
    Please enter two character state abbreviation.
  10. Zip Code(*)
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  11. Emergency Contact & Relationship(*)
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  12. Emergency Phone Number(*)
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  13. Child's Birth Date(*)
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  14. Your Email Address(*)
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  15. Grade Entering in August 2017(*)
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  16. Allergies or medical conditions?
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  17. Do you have a friend you would like to be placed with? If so, who?
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  18. Additional Comments
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