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VBS Child Registration
JUNE 24th - JUNE 28th, 2024
9:00am - 12:30pm
4501 Nielson Rd. Phelan CA 92371
760-868-5102
THIS EVENT IS FREE
ONE CHILD PER FORM
All information collected below is not shared and kept classified for privacy.
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* Indicates required question
CHILD LAST NAME
*
Your answer
CHILD FIRST NAME
*
Your answer
CHILD GRADE
*
KINDERGARTEN
1ST GRADE
2ND GRADE
3RD GRADE
4TH GRADE
5TH GRADE
CHILD'S BIRTH DATE (MM/DD/YYYY)
*
Your answer
CHILD ALLERGIES OR MEDICAL CONDITIONS
*
Your answer
PARENT LAST NAME
*
Your answer
PARENT FIRST NAME
*
Your answer
PARENT PHONE NUMBER
*
Your answer
EMERGENCY CONTACT NAME
*
Your answer
EMERGENCY CONTACT PHONE NUMBER
*
Your answer
EMERGENCY CONTACT RELATION TO CHILD
*
Your answer
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