VBS Registration Form 2017
***Note: All children must be 3 yrs old by June 1st and potty trained.
Parent/Guardian Name
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Primary Phone Number
Your answer
Secondary Phone Number
Your answer
Home Church
Your answer
Email Address
Your answer
Emergency Contact Number
Your answer
Adults who will pick up your child
Your answer
Child 1
Child's Last Name
Your answer
Child's First Name
Your answer
DOB
Must be 3-yrs by June 1st & potty trained.
Your answer
Grade Completed
Your answer
School Attending
Your answer
Allergies/Medications/Health Concerns
Your answer
Friend your child would like to have in their group.
Your answer
Additional notes regarding your child
Your answer
Child 2
Child's Last Name
Your answer
Child's First Name
Your answer
DOB
Must be 3-yrs by June 1st & potty trained.
Your answer
Grade Completed
Your answer
School Attending
Your answer
Allergies/Medications/Health Concerns
Your answer
Friend your child would like to have in their group.
Your answer
Additional notes regarding your child
Your answer
Child 3
Child's Last Name
Your answer
Child's First Name
Your answer
DOB
Must be 3-yrs by June 1st & potty trained.
Your answer
Grade Completed
Your answer
School Attending
Your answer
Allergies/Medications/Health Concerns
Your answer
Friend your child would like to have in their group.
Your answer
Additional notes regarding your child
Your answer
Child 4
Child's Last Name
Your answer
Child's First Name
Your answer
DOB
Must be 3-yrs by June 1st & potty trained.
Your answer
Grade Completed
Your answer
School Attending
Your answer
Allergies/Medications/Health Concerns
Grades 1-5 Complete
Your answer
Friend your child would like to have in their group.
Your answer
Additional notes regarding your child
Your answer
Child 5
Child's Last Name
Your answer
Child's First Name
Your answer
DOB
Must be 3-yrs by June 1st & potty trained.
Your answer
Grade Completed
Your answer
School Attending
Your answer
Allergies/Medications/Health Concerns
Grades 1-5 Complete
Your answer
Friend your child would like to have in their group.
Your answer
Additional notes regarding your child
Your answer
Submit
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