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2019 VBS - Child Registration
June 24-28, 2019
9am-12pm
Event Address: 4501 Nielson Rd. Phelan, CA 92371
Contact us at (760) 868-5102
Child's Last Name *
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Child's First Name *
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Age *
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Gender *
Required
Grade Entering *
Parent Name *
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Address *
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Phone Number *
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Email Address *
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Allergies or Other Medical Conditions
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Emergency Contact Name *
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Emergency Contact Phone *
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Emergency Contact Relationship to Child *
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How did you hear about this event?
Comments and/or questions
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