VBS Registration
Event Timing: June 26th-30th, 2017 6pm-8:30pm
Event Address: 9717 Bond Rd. Elk Grove, CA 95624
Contact Stacey Bunting at (916) 718-1451 or godscrewatcobc@gmail.com
Email address *
Child's Name *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Age *
Your answer
Grade Group *
(select grade child is going into)
Medical Information *
Please include any allergies/medications
Your answer
Mother's Name: *
Your answer
Address
Your answer
Phone Number
Your answer
Father's Name *
Your answer
Address
Same as above
Your answer
Phone Number
Your answer
Emergency Contact Information *
Name, Best number to be reached at, Relationship to participant
Your answer
May we have permission to photograph your child?
Do you attend a church?
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