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2022 RiverKids VBS Student Registration
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Nick Name
Your answer
Gender
Male
Female
Clear selection
Birth date (Month/Day/Year)
*
MM
/
DD
/
YYYY
School Age Grade Completed
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th grade
3 years old *must be potty trained
4 years old *must be potty trained
Under 3 (Nursery) *Parent/Guardian must volunteer
Primary Parent/Guardian Name (First & Last Name)
*
Your answer
Primary Parent/Guardian Cell Number
*
Your answer
Primary Parent/Guardian Email
*
Your answer
Secondary Parent/Guardian Name (First & Last Name)
Your answer
Secondary Parent/Guardian Cell Number
Your answer
Secondary Parent/Guardian Email
Your answer
Phone Number (Home):
Your answer
Address:
*
Your answer
City:
*
Your answer
State:
*
Your answer
Zip Code:
*
Your answer
Siblings (Name & Age)
Your answer
Is the parent/family member of this child volunteering?
*
Yes
No
Would you be interested in volunteering?
*
Yes
No
Maybe
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