2025 VBS Registration Form

One form per child

 

Child's Name *

First

Last

Email *

Mailing Address *

Child's Birthday

Entering Grade

GenderMaleFemale

Parent's Name *

First

Last

Parents/guardian address if different from above

Parent Email address *

Parent Cell Phone number

Name of person who may pick up child *

First

Last

Emergency Contact Person *

First

Last

Emergency Contact Phone Number

Relationship to Student

Food Allergies

• Yes
• No

If YES, List food allergies

Medical Concerns

• Yes
• No

If Yes, List Medical Concerns/Conditions

Permission to Photograph/Video Child for the purpose of VBS promotion only

• Yes
• No

Single Line Text

Submit