MSBC VBS REGISTRATION

Please Register Each Child Planning to Attend MSBC VBS This Year
1. Child #1*

First NameLast Name
Child's Age*
Gender*
Grade Completed
2. Child #2

First NameLast Name
Child's Age
Gender
Grade Completed
3. Child #3

First NameLast Name
Child's Age
Gender
Grade Completed
4. Child #4

First NameLast Name
Child's Age
Gender
Grade Completed
5. Child #5

First NameLast Name
Child's Age
Gender
Grade Completed
Allergies / Medical Information
Child Related Comments:
Parent / Guardian Contact Information
Name of Parent / Guardian*

First NameLast Name
Primary Phone*

Area CodePhone Number
Alternate Phone

Area CodePhone Number
E-mail
Local Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact

First NameLast Name
Emergency Phone

Area CodePhone Number
Other Comments
Thank You for completing the Online Registration Form!

After you click the Submit Button below, you will be redirected

back to the MSBC VBS Main Page!
Should be Empty: