Simple Event Registration Form

Simple Event Registration Form

VBS 2016 Registration

Fill out the form to register your child for VBS.
Child's Name*

First NameLast Name
Parent/ Guardian's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Primary Phone*
Format: (000) 000-0000.
Secondary Phone
Format: (000) 000-0000.
E-mail*
Medical Information
Medications, Allerigies, etc.
Emergency Contacts (other than listed above)
Name
Phone
Format: (000) 000-0000.
Name
Phone
Format: (000) 000-0000.
Dismissal Information*
Who may pick up your child at the end of each VBS day?
Visiting?
Is your child visiting or a regular at CCO?
YesNo
Should be Empty: