Forms


Up to 3 siblings living in the same household may be entered per form. For 4 or more or for siblings who do not live together, please fill out separate form.

Parent/Guardian Name:
Street Address:
City, State ZIP:
,
Preferred Phone Number:
Alternate Phone Number:
Email Address:
Does Your Family Addend NSCC?
Yes No
How Many Of Your Children Will Be Attending VBS?
Childs Name:
Nickname:
Grade Completed in June, 2018:
Please List ALL Allergies, Including Dietary, Medical and Seasonal:
Please List ANY Medical Conditions:
Emergency Contact Name:
Other Than Parents Listed Above
Relationship To Child:
Cell Phone Number:
Second Emergency Contact Name:
Other Than Parents Listed Above
Relationship To Child:
Cell Phone Number:
Other Adults Authorized To Pick Up Child(ren):
Relationship To Child:
Cell Phone Number:
Other Adults Authorized To Pick Up Child(ren):
Relationship To Child:
Cell Phone Number:
Please Give Any Information That We Need To Know About Your Child(ren):
Do We Have Permission To Photograph And Video Tape Your Child)ren)?
All images are property of NSCC
YES NO



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 North Strand Community Church
2582 Mt. Zion Road
Little River, SC 29566

843-399-7729

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