VBS Child Registration
VBS June 25-28 2018
First and Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Parent First and Last Name *
Your answer
Address (street, city, state, zip) *
Your answer
Phone number - cell preferred *
Your answer
Email for Parent *
Your answer
Emergency Contact (name, relationship & Phone) *
Your answer
What grade was your child in for the 2017-2018 school year? *
Indicate your child's age range *
Is there another child your child wants to be paired with? If yes, list names in "other" *
How did you hear about our VBS Program? *
Please list your child's allergies or medical concerns. Write "none" if there are none. *
Your answer
Who can your child leave with? List Name and relationship to the child. *
Your answer
May we have permission to photograph your child? This may be posted on Facebook, our website, or other social media. *
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