VBS Sign Up CVAG
Dates: July 13-16, 5:00-7:30pm
For Children: 3 years old - 6th grade
FOR ANY QUESTIONS or MORE INFO PLEASE EMAIL jlittrell@mycvag.org
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Parent/Guardian Full Name *
Parent/Guardian Phone Number  *
Parent/Guardian Email Address  *
Address, City, State, Zip code *
Emergency Contact Name
**If parent/guardian cannot be contacted**
 *
Emergency Contact Phone Number
**If parent/guardian cannot be contacted**
 *
Child's Full Name *
Child's Gender *
Child's Date of Birth *
MM
/
DD
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YYYY
Child's Age *
Please list any Chronic/Recurring Conditions or Allergies. PLEASE INCLUDE ANY FOOD ALLERGIES.
Are any activities restricted?
Please list ALL adults allowed to pick up your child(ren) from VBS. If their name is not included, we will have to contact the parent/guardian and get permission before releasing the child.  *
Do you have another child to add? *
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