VBS Registration

VBS REGISTRATION
Grades 1st - 5th Grade

* Indicates required field

Child's Name *

First

Last

Grade going into *

Child's Name *

First

Last

Grade going into *

Child's Name *

First

Last

Grade going into *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Child's Name *

First

Last

Grade going into *

Child's Name *

First

Last

Grade going into *

Child's Name *

First

Last

Grade going into *

Medical Information (please include things such as food allergies) *

Parent/Guardian Name *

First

Last

Email *

Phone Number *

Individual Picking up Child/Children *

First

Last

Emergency Contact *

First

Last

Phone Number *

Emergency Contact *

First

Last

Phone Number *

Do you attend a church? *

Yes No

If yes, what church? *

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