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VBS REGISTRATION
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* Indicates required question
Childs Name
*
Your answer
Parent/ Guardian Name
*
Your answer
Physical Address
*
Your answer
Mailing Address
*
Your answer
Phone Number
*
Your answer
Childs Birthday (m/d/yy)
*
Your answer
Last Grade Completed
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
How will your Child ARRIVE at VBS?
*
Dropped Off
Van Rider
Walker
How will your child be PICKED UP from VBS?
*
Picked up
Van Rider
Walker
Who other than parent/guardian may pick child up?
*
Your answer
Do we have permission to Photograph your child?
*
YES
NO
Is there any medical information or other important information we need to be aware of including food allergies
*
Your answer
Emergency Contacts (please list two)
*
Your answer
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