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MAR THOMA PARISH , PERTH

VBS REGISTRATION FORM 2012

Get Set Go Luke 10:3


1) Full Name (Child I) : DOB (DD/MM/YY) : 2) Full Name (Child II) : DOB (DD/MM/YY) : Age : Grade at School :

Age :

Grade at School :

Contact Details
Parent Name : Address : Tel (H) : Email : Emergency Contact :

Tel (M) :

Do you consent to medications being administered to this child in case of an emergency? YES/ NO Are there any allergies or medical condition that we need to be aware of?

__________________________________________________________
I give permission to my child/children to attend the VBS. Parent / Guardian Signature : Date :

---------------------------------------------------------------------------------------------Office Use Only


Registration No : Paid : Date of Payment : Contact Details: Rev. Mothy Varkey (0426 283 829) Babbin Bijoe (0413 812 078) Neeta Sanju (0401 291 344)

Registration Fees : AUD 15.00 per child

Should you require more forms - Please visit our website www.perthmarthoma.org.au

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