VBS Registration Form Please enable JavaScript in your browser to complete this form.Child's Name *Street Address *City *State *Zip Code *Home Phone Number *Cell Phone Number *Home Email AddressChild's Date Of Birth *Child's School Grade completed June, 2024 *Emergency Contact Name *Emergency Contact relationship to child *Emergency Contact Phone Number *Child's Mother's Name *Child's Father's Name *Child's Allergies *Child's Medical Concerns *Child's Home ChurchInvited to VBS by:Child will be dismissed to: (If different on any night or if child is to leave earlier than dismissal time, written permission must be submitted) *Permission for child's picture to be taken and possibly shown on social media? *YesNoSubmit
