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Baptist Church

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VBS REGISTRATION

Primary Contact Name

Primary Phone

Secondary Contact Name

Secondary Phone

Address

City, State, ZIP

Child's Name

Child's Age

Food Allergies?

Food Allergies

Thank you for registering!

July 30th-Friday August 4th

6:30pm-9:00pm

4 years old- 6th grade

(804) 794-7054

Baptist Church

Gospel Light Baptist Church

2109 Anderson Highway

Powhatan, VA 23139

Gospel Light Baptist Church

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