VBS Registration form
  • June 5-9 and graduation on June 10, 2023
6:00 pm to 8:30 pm
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Child’s name (First and Last name): *
Child’s nickname: *
 Child’s age: *
Date of birth: *
Name of parents/guardians: *
Parent/guardian’s cell phone: *
Parent/guardian’s email address: *
Home address *
Custodial arrangement if applicable:
Allergies or other medical conditions (i.e. diabetes): *
In case of emergency, contact (include name and phone number: *
I give permission to call 911 in case of an emergency. *
Photographs will be taken during VBS.  I am giving permission for my child’s photo to be taken. *
Would you like to share any information regarding your child’s special needs? If you selected yes, a special needs survey form will be emailed to you.
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