VBS Registration form

JULY 10-14, 20176-8 P.M.

Please fill out one registration form for each child

Child's Name *
Child's Name
Date of birth *
Date of birth
Parent's Name *
Parent's Name
Address *
Address
Phone Number During VBS *
Phone Number During VBS
In Case of Emergency Contact *
In Case of Emergency Contact
Emergency Contact Phone Number *
Emergency Contact Phone Number