VCC's VBS Registration
Please fill out one form PER CHILD
Email address *
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Gender *
Date of Birth *
MM
/
DD
/
YYYY
Child's Age
Your answer
Last School Grade Completed *
Parent Name (Last name if different) *
Your answer
Street Address, City, State, Zip *
Your answer
Telephone Number *
Your answer
Home Church
Your answer
Allergies or Medical Conditions (ex. peanuts, asthma, none) *
Your answer
In case of emergency contact (Other than parent listed above) *
Your answer
Emergency Contact's Phone Number *
Your answer
Emergency Contact's Relationship to child
Your answer
How did you find out about this event?
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