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VBS Kids Registration
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* Indicates required question
Child 1 (Required)
First & Last Name
*
Your answer
Grade Entering 2024-2025 School Year
*
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Birthday
*
MM
/
DD
/
YYYY
Parent Name(s)
*
Your answer
Home Address
*
Your answer
Phone Number
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
Food allergies?
*
Yes
No
If yes, please list:
Your answer
Medical concerns?
*
Yes
No
If yes, please list:
Your answer
Family Doctor Name
Your answer
Family Doctor Phone Number
Your answer
Do you have a home church?
Yes
No
Clear selection
If so, where?
Your answer
Name of person(s) who has permission to pick up
*
Your answer
Permission to take pictures and post on media?
*
Yes
No
Any other comments
Your answer
Child 2 (if applicable)
First & Last Name
Your answer
Grade Entering 2024-2025 School Year
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Clear selection
Birthday
MM
/
DD
/
YYYY
Food allergies?
Yes
No
Clear selection
If yes, please list:
Your answer
Medical concerns?
Yes
No
Clear selection
If yes, please list:
Your answer
Permission to take pictures and post on media?
Yes
No
Clear selection
Any other comments
Your answer
Child 3 (if applicable)
First & Last Name
Your answer
Grade Entering 2024-2025 School Year
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Clear selection
Birthday
MM
/
DD
/
YYYY
Food allergies?
Yes
No
Clear selection
If yes, please list:
Your answer
Medical concerns?
Yes
No
Clear selection
If yes, please list:
Your answer
Permission to take pictures and post on media?
Yes
No
Clear selection
Any other comments
Your answer
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