May 26, 27, 28, 2026 5:00pm-8:00pm
Pre-Kindergarten - 4th Grade (meal provided)
Current Grade
*
Please Select
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
2025-26 School Year
Child's Name
*
Please list only 1 child per registration form.
Guardian Information
*
Name(s)
Preferred Phone Number
*
-
Area Code
Phone Number
Email Address
Emergency Contact
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Medical Information
*
Are there any medical conditions that LCOOR Staff/Volunteers should be aware of?
Permission
In the case of a medical emergency, at a time when I cannot be reached, I grant LCOOR staff/volunteers permission to treat my child in any way deemed necessary. I absolve LCOOR Staff and Volunteers from liability in acting on my behalf in this regard.
I hereby grant the LCOOR Staff/Volunteers permission to photograph/film (social media) the minor designated above in any manner or form for any lawful purpose associated with this VBS program.
Signature
Submit
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