REGISTRATION FORM
(ONE PER CHILD)
Child's Name (First and Last)
First Name
Last Name
Crew Leader Name
(This section to be filled out by registration team)
Child's Nickname:
Child's Age:
Date of Birth:
-
Month
-
Day
Year
Date
Name of Parents/Guardians:
Street Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parents/Guardian's Cell Phone:
Format: (000) 000-0000.
Parents/Guardian's Email Address:
example@example.com
Allergies or othere medical conditions (i.e. diabetes):
In case of emergency, contact:
Phone:
Format: (000) 000-0000.
Relationship to Child:
I give permission to call 911 in case of emergency.
Photographs will be taken during VBS. My signature indicates I am giving permission for my child's photo to be taken.
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Should be Empty: