VBS Signup Form
Please fill out one form per child. Your information will be sent to VBS Director and all information is confidential for your protection. Thanks and see you July 31st - August 4th
Child's Information
Child's First and Last Name
Your answer
Child's Birth Date
MM
/
DD
/
YYYY
Grade Level they have finished
Any allergies or medication information that we need to know about?
Your answer
Name of special friend your child wants to be with
Your answer
Parent Information
Please Enter information in all areas for our record and safety of your child/children
Parent/Guardian's Name (Father)
Your answer
Cell Phone Contact
Your answer
Parent/Guardian's Name (Mother)
Your answer
Cell Phone Contact
Your answer
Home Address
Your answer
Home Email
Your answer
Home Phone Number
Your answer
Emergency Contact (Name and Number)
Your answer
Comments
Required
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