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MONUMENTAL VBS - CHILD REGISTRATION
VBS at St. Matthew's Episcopal Church in Sterling, VA. Please complete 1 registration for each child attending.
Should you have any questions about registration, please contact
office@stmtts.org
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* Indicates required question
Email
*
Your email
Child First Name
*
Your answer
Child Last Name
*
Your answer
Child Grade Entering (in fall of 2022)
*
Your answer
Child Gender
*
Your answer
Child Date of Birth
*
MM
/
DD
/
YYYY
Child Shirt Size
*
Choose
Youth XS
Youth S
Youth M
Youth L
Adult XS
Adult M
Adult L
Adult XL
Child Allergies
*
Your answer
Child Medical Concerns
*
Your answer
Is there a friend your child would like to be placed with?
*
Your answer
Parent/Guardian First Name
*
Your answer
Parent/Guardian Last Name
*
Your answer
Parent/Guardian Email
*
Your answer
Parent/Guardian Address 1
*
Your answer
Parent/Guardian Address 2
*
Your answer
Parent/Guardian City
*
Your answer
Parent/Guardian State
*
Your answer
Parent/Guardian Zip
*
Your answer
Parent/Guardian Contact Phone 1
*
Your answer
Parent/Guardian Contact Phone 2
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Relationship
*
Your answer
Emergency Contact Phone
*
Your answer
Alternate Adult Allowed to Pick Up Child - Name
*
Your answer
Alternate Adult Allowed to Pick Up Child - Phone
*
Your answer
Additional Comments
*
Your answer
A copy of your responses will be emailed to the address you provided.
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