VBS Registration
Please fill out a separate form for EACH child you are registering
Email address *
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Age *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Gender *
Your answer
Last School Grade Completed *
Your answer
Parent/Caregiver First Name *
Your answer
Parent/Caregiver Last Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
ZIP Code *
Your answer
Home Phone *
Your answer
Parent/Caregiver Cell Phone *
Your answer
Contact Email Address *
Your answer
Your Home Church *
Your answer
Allergies or Other Medical Conditions
Your answer
Emergency Contact First Name *
Your answer
Emergency Contact Last Name *
Your answer
Emergency Contact Phone *
Your answer
Emergency Contact Relationship to Child *
Your answer
Anything else you would like us to know about your child or family?
Your answer
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This form was created inside of Castleton United Methodist Church.