Fear Busters 8 Week Series
Please fill out this form and click submit.
One form per child. Please do not include multiple names. Otherwise you will be ask to do this when dropping your child off. Thank You
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Name
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Email
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This address will receive a confirmation email
Phone
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Child's Birthday
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Address
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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
Allergies or concerns that we need to be aware of?
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Emergency Contact Name
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Emergency Phone
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You understand your responibility for transportation of your child. Mt Zion Church members and guest are not responsible for transportation? You agree and will abide by pick up and drop off times for your child.
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Please select one option.
Yes
Do you give Mt Zion the permission to treat any non series injuries that possibly could occur. You understand that we do not and will not give any medication to any child at any given time.
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Please select one option.
yes
You agree that Mt Zion Members and guest will not tolorate voilent behavior, inapropriate language, distruction of property. No Stealing, We are not responsible for ones belongings, no weapons or anything there of that would contribute to anything other than the good of human kind. We will treat one another with the upmost respect love and kindness while on the premisis.
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Please select one option.
yes
We invite you to join our Sunday service while your child is attending. However you are not required to do so. We would just like to know if this is a possible interest you may have in joining us for a service? We Thank you and God Bless
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Please select all that apply.
Yes, I would like to attend
No, not at this time but maybe in the future
No, Not at all
Submit
Description
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