VBS 2019 Registration
Please fill out a registration form for each child. If you are registering multiple children, you can fill out this form multiple times.
Email address *
Child's Name (one child per form) *
Your answer
Parent / Guardian Name *
Your answer
Address *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Grade in school (2019-20 school year). To participate in VBS students must be entering 1st-5th grade. *
Parent / Guardian Phone Number *
Your answer
Emergency Contact in case Parent / Guardian cannot be reached *
Your answer
Emergency Contact relation to student *
Your answer
Emergency Contact phone number *
Your answer
Please list any food allergies or other medical concerns that our staff should be aware of. (If there are no concerns, you may leave this blank).
Your answer
A copy of your responses will be emailed to the address you provided.
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