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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