Week and Class for Child (Class based on age or Grade child is entering in the fall) (Sorry, 3rd Grade and 5th/6th Grade classes are closed.) (Pick one) *
Child's Age on July 29, 2022 (Must be at least 3-year-old and potty trained). *
Your answer
Parent's First and Last Name(s) *
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Parent's Cell Phone Number *
Your answer
Parent's Email *
Your answer
Address (Street, City) *
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Allergies or Medical Conditions (or type NONE) *
Your answer
In Case of Emergency Contact Name *
Your answer
Emergency Contact Relationship to Child *
Your answer
Emergency Phone Number During VBS *
Your answer
Names authorized to pick up your child. *
Your answer
A copy of your responses will be emailed to the address you provided.