VBS Registration
Zoomerang 2022
Child's Name:
*
First Name
Last Name
Date of Birth:
*
Age:
*
School Grade in the Fall:
*
Parent/Guardian:
*
Address:
*
Street Address
Street Address 2
City
State / Province
Postal / Zip Code
Phone Number:
*
Please enter a valid phone number.
Email:
example@example.com
Name of person bringing child:
*
How did you hear about our VBS?
*
Additional information we may need to know about your child:
*
Emergency Information
Person to Contact:
*
Phone Number:
*
Please enter a valid phone number.
Allergies/Medical Information:
*
Siblings at VBS (names and grades):
*
Will the child be riding a bike/walking to the event?
*
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Submit
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