Parent/Guardian Name
First Name
Last Name
Email
example@example.com
Cell Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact (this person will also be authorized to pick-up from VBS:
First Name
Last Name
Emergency Contact Phone #
Please enter a valid phone number.
Format: (000) 000-0000.
Yes, you can take pictures of my children to possibly be used on our website or social media:
Yes
No
Home Church:
My child(ren) was invited by a friend/member from First Presbyterian to attend: (list name below):
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Child Information
Name
*
First Name
Last Name
Age
T-Shirt Size
Birthday
*
-
Month
-
Day
Year
Date
Grade completed in the 25/26 school year:
*
Please Select
PreK(Must be 3yrs old & potty trained)
Kdgt
1st
2nd
3rd
4th
5th
Please list any allergies or important information below:
*
Are you signing up additional children?
*
Yes
No
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Child #2
Name
First Name
Last Name
Age
T-Shirt Size
Birthday:
-
Month
-
Day
Year
Date
Grade completed in the 25/26 school year:
*
Please Select
PreK(Must be 3yrs old & potty trained)
Kdgt
1st
2nd
3rd
4th
5th
Please list any allergies/important info below:
*
Are you signing up additional children?
*
Yes
No
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Child #3
Name
First Name
Last Name
Age
T-Shirt Size
Birthday:
-
Month
-
Day
Year
Date
Grade completed in the 25/26 school year:
*
Please Select
PreK(Must be 3yrs old & potty trained)
Kdgt
1st
2nd
3rd
4th
5th
Please list any allergies/important info below below:
*
Are you signing up additional children?
*
Yes
No
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Next
Child #4
Name
First Name
Last Name
Age
T-Shirt Size
Birthday:
-
Month
-
Day
Year
Date
Grade completed in the 25/26 school year:
Please Select
PreK(Must be 3yrs old & potty trained)
Kdgt
1st
2nd
3rd
4th
5th
Please list any allergies/important info below:
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I hereby authorize staff and volunteers of VBS to administer minor and/or emergency medical treatment to my child
*
Yes
No
Preferred Hospital
*
Insurance Information
Company
Policy or Group #
Submit
Should be Empty: