JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
2022 VBS Registration
Please complete the information in this form so we can provide a safe, supportive environment for your child.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Child's name
*
Your answer
Child's Age
*
Your answer
Child's Birth Date
*
MM
/
DD
/
YYYY
Address
*
Your answer
Last School Grade Completed
*
Your answer
Name of Parent/Guardian #1
*
Your answer
Phone Number of Parent/Guardian #1
*
Your answer
Email Address of Parent/Guardian #1
*
Your answer
May Parent/Guardian #1 Pick Up Child
*
Yes
No
Required
Name of Parent/Guardian #2
Your answer
Phone Number of Parent/Guardian #2
Your answer
Email address of Parent/Guardian #2
Your answer
May Parent/Guardian #2 Pick Up Child
Yes
No
Please list name and phone number of any other adults who will be picking up your child.
Your answer
Child's Known Allergies or Medical Conditions
*
Your answer
Is there anything else we need to know to better serve your child?
Your answer
I give permission for my child to appear in photos and/or video footage taken throughout the week.
*
Yes
No
Required
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
