VBS REgistration Details:
JUNE 25-29| 5:30-8:30PM
Child Name
*
First Name
Last Name
Child Grade Completed
*
Please Select
Prek-K
1st
2nd
3rd
4th
5th
Consent to Photograph for Social Media.
Yes
No
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/ Gaurdian
First Name
Last Name
Parent/ Gaurdian Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Emergency Contact 2
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Are there any other authorized people to pick up your child? list names and contact bellow.
*
Will be attending dinner at 5:30pm?
yes
no
Will attend end of week block party on Thursday, June 29?
yes
no
Submit
Should be Empty: