Please register one child at a time. Thank you!

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Child's Name*

Child's Birthdate*

Parent or Guardian's Name*

Street Address*

State*

City*

Zip Code*

Phone Number where you can be reached during VBS*

Parent or Guardians Email*

Grade Entering This Fall*
K1234567

Known Allergies or Medical Conditions

Medications Needed While at VBS

Name of siblings attending VBS this year

I will be attending the Friday Lunch & Closing Program*
YesNoMaybe

Transportation Is Available*
Transportation Needed