VBS Registration Form
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Gender *
Your answer
Child's Age *
Your answer
Date of Birth *
Your answer
Last School Grade Completed *
Parent's Name *
Your answer
Street Address (including City, State, Zip) *
Your answer
Telephone Number *
Your answer
E-mail Address
Your answer
Home Church
Your answer
Allergies or other Medical Conditions *
Your answer
Emergency Contact (Name and Phone Number) *
Your answer
Emergency Contact's Relationship to Child *
Your answer
This year we will have an organized car line dismissal. Each person picking up a child will receive a number that is linked to that child. Please list the name of the person who will be picking up your child each night. *
Your answer
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