VBS Registration Form
Parent/Guardian:
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
Emergency Contact Name:
Relationship to Child:
Ph. #:
Format: (000) 000-0000.
Who can pick up your child/children?
Name of Home Church:
YOUR CHILD/CHILDREN AGES 4 - 6TH GRADE:
Name:
DOB:
-
Month
-
Day
Year
Date
Age: years
Grade Completed in Spring:
Pictures Allowed:
Yes
No
Allergies:
Yes
No
If yes, list:
Medical Concerns:
Yes
No
If yes, list:
Name:
DOB:
-
Month
-
Day
Year
Date
Age: years
Grade Completed in Spring:
Pictures Allowed:
Yes
No
Allergies:
Yes
No
If yes, list:
Medical Concerns:
Yes
No
If yes, list:
Name:
DOB:
-
Month
-
Day
Year
Date
Age: years
Grade Completed in Spring:
Pictures Allowed:
Yes
No
Allergies:
Yes
No
If yes, list:
Medical Concerns:
Yes
No
If yes, list:
Name:
DOB:
-
Month
-
Day
Year
Date
Age: years
Grade Completed in Spring:
Pictures Allowed:
Yes
No
Allergies:
Yes
No
If yes, list:
Medical Concerns:
Yes
No
If yes, list:
Name:
DOB:
-
Month
-
Day
Year
Date
Age: years
Grade Completed in Spring:
Pictures Allowed:
Yes
No
Allergies:
Yes
No
If yes, list:
Medical Concerns:
Yes
No
If yes, list:
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