VBX Registration
Bayside of Placerville VBX Registration for rising K-5 Graders.
VBX is June 25-28 6:30-8:30pm at Bayside Church of Placerville
Contact Heather Cook at 530-626-7288 for more information.
Email address *
Student Registration
Student's Name *
Your answer
Date of Birth *
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Street Address: *
Your answer
Grade Completed in 2018 *
Allergies/Medical Conditions/Special Needs/Concerns:
Your answer
Emergency Contact Information
Parent/Guardian Name *
Your answer
Phone Number *
Your answer
Alternate Pick-Up Person & Phone *
Your answer
Alternate Emergency Contact Person: Name & Phone Number *
Your answer
A copy of your responses will be emailed to the address you provided.
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