NorthRidge Seneca VBS Registration 2017
Please fill out one for each child eligible to attend.
Child's Last Name *
Your answer
Child's First Name *
Your answer
Grade Entering in Fall *
Parent/Caretaker Name *
Your answer
Address *
Your answer
Phone # *
Your answer
May we send text messages to this number in case of emergency?
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
List the name(s) of anyone else that may pick up your child.
Your answer
Special Concerns
Your answer
How many people in your family will attend the ending celebration?
Your answer
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