VBS Registration 

Child/Student Name *
Child/Student Name
Parent/Guardian Name *
Parent/Guardian Name
Address *
Address
Phone *
Phone
Child's Birth Date *
Child's Birth Date
Medical or other information we need to know about your child. (Please include any food allergies)
Emergency Contact Name
Emergency Contact Name
Emergency Contact Phone Number
Emergency Contact Phone Number
Who may pick up your child at the end of each VBS day?
Do we have permission to photograph your child? *
Do we have permission to use your child's photograph for the purpose of promotion? *