VBS Registration
Register for VBS
Child's name *
Your answer
Address *
Your answer
Address 2nd line (if needed)
Your answer
City *
Your answer
State *
Your answer
Phone number *
Your answer
Email address
Your answer
Medical conditions or allergies (leave blank if none)
Your answer
Do you attend church? *
Required
If yes where?
Your answer
Guest of...?
Your answer
Parent/Guardian name *
Your answer
Parent/Guardian phone *
Your answer
Emergency contact *
Required
Emergency contact phone *
Required
Authorized pick-up *
Your answer
Last grade completed *
Your answer
Child's Birthday
MM
/
DD
/
YYYY
Child's Gender
Do we have permission to post pictures of your child online? *
Required
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