Smith Grove VBS Registration Form (July 2021)
Register your children (entering kindergarten-6th grade) for our VBS. Please provide the requested information for each child and contact information for an adult. Please register by July 18.
Child(ren)'s Information
How many children do you need to register? (If more than 6, please submit a second form).
*
1
2
3
4
5
6
1st child's Name
*
First Name
Last Name
1st child's Age
*
1st child's Birthday
*
-
Month
-
Day
Year
Date
Grade 1st child is entering in Fall 2021
*
Kindergarten
1st
2nd
3rd
4th
5th
6th
2nd child's Name
*
First Name
Last Name
2nd child's Age
*
2nd child's Birthday
*
-
Month
-
Day
Year
Date
Grade 2nd child is entering in Fall 2021
*
Kindergarten
1st
2nd
3rd
4th
5th
6th
3rd child's Name
*
First Name
Last Name
3rd child's Age
*
3rd child's Birthday
*
-
Month
-
Day
Year
Date
Grade 3rd child is entering in Fall 2021
*
Kindergarten
1st
2nd
3rd
4th
5th
6th
4th child's Name
*
First Name
Last Name
4th child's Age
*
4th child's Birthday
*
-
Month
-
Day
Year
Date
Grade 4th child is entering in Fall 2021
*
Kindergarten
1st
2nd
3rd
4th
5th
6th
5th child's Name
*
First Name
Last Name
5th child's Age
*
5th child's Birthday
*
-
Month
-
Day
Year
Date
Grade 5th child is entering in Fall 2021
*
Kindergarten
1st
2nd
3rd
4th
5th
6th
6th child's Name
*
First Name
Last Name
6th child's Age
*
6th child's Birthday
*
-
Month
-
Day
Year
Date
Grade 6th child is entering in Fall 2021
*
Kindergarten
1st
2nd
3rd
4th
5th
6th
We will be taking photos throughout the week. May we have permission to use photos including your children on our social media and/or website?
*
Yes
No
Is there any additional information we need to know about your child (ie, allergies, medical information, etc)?
Parental Contact Information
Name of best Parent/Guardian contact:
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
May we text this number?
*
Yes
No
Email
*
example@example.com
Please list any names and contact information for adults (including yourself) who may pick up your children. If someone who is not listed here attempts to pick up your child, we will contact a parent before releasing the child.
*
Please verify that you are human
*
Submit
Should be Empty: