VBS Registration Form

Child's Name

Child's Age & Birthdate:

Grade completed in school

Allergies or Medical Conditions we should be aware of:

Parent / Caregiver Name:

This address will receive a confirmation email

Phone

Address

Photo Consent - Your child may be photographed or videoed during our activities. If used online, no names will the included. I give my permission:

Yes No

Who can pick up your child from VBS (include phone #)

Description

August 4-7 from 9 - 11:30 a.m.

Please fill out this form for each child and click submit.