Camp Canopy VBS 2019
Enter the information below to register your child for our upcoming VBS program. If you have any issues registering, please contact the VBS director.
July 29th - August 2nd
Dinner from 5:30 PM - 6:00 PM; VBS from 6:00 PM - 8:00 PM
We will be serving a light dinner at 5:30 pm. Please check the days that your child will be joining us for dinner. *
Required
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Gender *
Date of Birth *
MM
/
DD
/
YYYY
Grade Completed *
Age *
Your answer
Parent's First Name(s) *
Your answer
Parent's Last Name(s) *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Primary Phone Number *
Your answer
Secondary Phone Number
Your answer
Email
Your answer
Emergency Contact Name(s) *
Your answer
Emergency Phone Number *
Your answer
Special Needs/Allergies
Your answer
I give permission for my child to be picked up by the following person(s). They will NOT be release to anyone not listed. *
Your answer
Relationship to the Child *
Your answer
Child Shirt Size *
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