River Rock Kids Spotlight on VBS Student Registration Form
July 15th -18th (Tuesday - Friday) 8:30am - 12:00pm Ages 4 years old - 5th grade
Student Name
First Name
Last Name
Parent Name
First Name
Last Name
Parent Email
example@example.com
Parent Phone Number
Age of student
If your child has a food allergy, please list below
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Comments
Submit Application
Clear Fields
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