Registration - VBS 2022

Registration - VBS June 2022

* Indicates required field

Child's Name *

First

Last

Parent's Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Child's Age *

Last grade completed in school *

Medical or other information we need to know. (Please include any food allergies.) *

Emergency Contact (other than listed above): Name & Phone number *

Emergency Contact #2 *

Dismissal Information: Who may pick up your child at the end of each VBS day? *

May we have permission to photograph your child for the purpose of adding pictures to our FaceBook or Website? *

Yes No

Submit