VBS Kid's Camp Registration
Please fill out one form for each child
Full Name of child
*
First Name
Last Name
Grade that the child is going into:
Birthdate
*
-
Month
-
Day
Year
Date
Please list any allergies or conditions that we should be aware of.
Parent's Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
*
E-mail
example@example.com
Emergency Contact
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Submit
Should be Empty: