Outback Rock VBS 2024 - Clayton Memorial Church of God

Outback Rock VBS 2024

Contact Details

Child's Name(Required)

First Last

Birthday(Required)

Child's Name (if more than one)

First Last

Birthday

Child's Name (if more than one)

First Last

Birthday

Child's Name (if more than one)

First Last

Birthday

Child's Name (if more than one)

First Last

Birthday

Parent/Guardian Name(Required)

First Last

Phone(Required)

Email(Required)

Enter Email Confirm Email

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Doctor & Insurance Information(Required)

Emergency Contact Information(Required)

First Last

Emergency Contact Phone Number(Required)

Please notify the CMC team of any allergies or medical needs for your student(s). If none, simply write "none."(Required)

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