2BC - 2019 VBS Registration
Kick-off Party - Sunday, June 23
3:00 - 5:00 at the Little Rock Zoo

VBS - Monday, June 24 - Thursday, June 27
5:00 Dinner
5:45 - 7:45 VBS

Child's name *
Your answer
Child's gender
Your answer
Child's age *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Last school grade completed *
Name of parent(s) *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Additional Phone Number
Your answer
Email address *
Your answer
List any allergies or other medical conditions. (If none, type "none.") *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Relationship to child *
Your answer
Name one friend your child would like to be in a group with. (We will try to accommodate.)
Your answer
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