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In The Wild VBS Registration Form
Please fill out a form for EACH child attending.
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* Indicates required question
Last Name
*
Your answer
First Name
*
Your answer
Age
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Last Completed Grade
*
Your answer
Gender
*
F
M
Parent/Guardian Name
*
Your answer
Phone Numbers
*
Your answer
Street Address
*
Your answer
Mailing Address (if different)
Your answer
Email Address
*
Your answer
T-Shirt Size
*
YS
YM
YL
YXL
S
M
L
XL
Emergency contact 1 (Name & Number)
*
Your answer
Emergency contact 2 (Name & Number)
*
Your answer
Special Concerns or Comments
*
(List all allergies, medications, medical conditions, etc..)
Your answer
Please remember to arrive by 5:45pm on June 24th to sign the waiver. Thank you and see you soon!
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