Register for VBS

Family Information

Address

Primary Phone

Alternate Phone

Relationship to Student Father Mother Grandfather Grandmother Great-grandfather Great-grandmother Brother Sister Uncle Aunt Guardian Foster Parent Granduncle Grandaunt Other

Phone Number

May we have permission to photograph your child? Yes No

May we have permission to use your child's photograph on our website and for the purpose of promotion? Yes No

Pickup Information 1 Who may pick up your child at the end of each VBS day? Please put their names in the box above.

Student Information

Gender

Birth Date

Age Group

Food Allergies

Details

Medical Concerns

Details

I have more students to register