2018 VBS Preregistration

Child's Name *
Child's Name
Please note: Children must be at least 3 years old and fully potty trained to participate in VBS.
Address *
Address
Note: Children are grouped together with children in the following age groups: Pre-k- K; 1st-3rd grades; 4th-6th grades
Mother's/ Guardian's Name *
Mother's/ Guardian's Name
Mother's/Guardian's Phone Number *
Mother's/Guardian's Phone Number
Father's/Guardian's Name *
Father's/Guardian's Name
Father's/Guardian's Phone Number *
Father's/Guardian's Phone Number
Emergency Contact *
Emergency Contact
Should we need to contact you and we cannot reach either parent, please leave us the name and phone number of someone we can call .
Emergency Contact's Phone Number *
Emergency Contact's Phone Number