VBS Registration Form
Please complete one per child
Child's Name
*
First Name
Last Name
Child's Age
*
Grade Entering in 23-24 School Year
Reminder: VBS is for children in grades Prek through 5th Grade
Grade Entering in 23-24 School Year
*
Reminder: VBS is for children in grades Prek through 5th Grade
Parent/Guardian's Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Secondary Parent/Guardian's Name (if applicable)
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Medical/Emergency Information
Please list any allergies or medical conditions that staff need to be aware of while your child is at VBS. (note that staff will not be able to administer medications)
*
Emergency Contact:
*
First Name
Last Name
Emergency Contact Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to child:
*
Submit
Should be Empty: