VBS REGISTRATION

June 16th and 17th - 8:30AM to 1PM


Parent or Guardian Info:
First Name: Last Name:
Evening Phone Number: Daytime Phone Number:
Cellular Phone Number: Email Address:
Address: City, State, Zip:
Name of Emerg. contact: Emergency Phone #
Are you interested in being a volunteer for this event?
(Different time slots and activities are available.)		 Yes  No  More info please
Child 1 Info:
Name: (First and Last) Date of Birth:
Grade in school: (This Fall)  
Food Allergies/Special Notes:
When does he/she plan to attend?Both Days  Thursday Only  Friday Only
Child 2 Info:
Name: (First and Last) Date of Birth:
Grade in school: (This Fall)  
Food Allergies/Special Notes:
When does he/she plan to attend?Both Days  Thursday Only  Friday Only
Child 3 Info:
Name: (First and Last) Date of Birth:
Grade in school: (This Fall)  
Food Allergies/Special Notes:
When does he/she plan to attend?Both Days  Thursday Only  Friday Only
Child 4 Info:
Name: (First and Last) Date of Birth:
Grade in school: (This Fall)  
Food Allergies/Special Notes:
When does he/she plan to attend?Both Days  Thursday Only  Friday Only