VBS REGISTRATION


Please fill out the form in all the applicable areas. Many areas are required fields. Your registration will not be complete until each required field has been filled in. Each participant must fill out the form separately. If you have two participants, you must register them separately.

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Child's Name *
Child's Name
Parent/Guardian Name *
Parent/Guardian Name
Child's Birth Date *
Child's Birth Date
Child's Age/Grade Entering *
If your child is ENTERING the 3rd grade in the 2018-19 school year, they will attend the 3rd grade class.
Address *
Address
Parent/Guardian Cell *
Parent/Guardian Cell
Work Phone
Work Phone
Emergency Contact *
Emergency Contact
Emergency Contact Phone *
Emergency Contact Phone
Who may pick up your child at the end of each VBS night?
May we have permission to photograph your child? *
May we have permission to use your child's photograph for the purpose of promotion? *