VBS 2019

Child's Name *
Child's Name
Parent/Guardian Name *
Parent/Guardian Name
Child's Birthdate *
Child's Birthdate
Child's Age/Grade Completed *
Please note any medical issues we should be aware of, including any food allergies.
Address *
Parent/Guardian Cell *
Parent/Guardian Cell
Emergency Contact *
Emergency Contact
Emergency Contact Phone *
Emergency Contact Phone
Please list the names of who is allowed to pick-up your child after each evening of VBS.
Do we have permission to photograph your child? *
Do we have permission to use your child's image on social media or our website? *