VBS Registration Form
Ages 4-9 years old, 3 year olds with parental supervision
Student's Name *
Your answer
Parent/Family/Guardian Name *
Your answer
Address *
Your answer
Email *
Your answer
Phone *
Your answer
Phone
Your answer
Phone
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Age *
Your answer
Last School Grade Completed *
Your answer
Home Church
Your answer
Allergies/Medical Information/Other *
Your answer
Emergency Contact *
Your answer
Emergency Contact
Your answer
Dismissal Information: Name(s) of person(s) who may pick up this child from VBS *
Your answer
Submit
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