Registration Form

Student's Name (required)

Parent/ Guardian's Name (required)

Address (required)

Your Email (required)

Phone Numbers
Home (required)

Cell (required)

Work (option)

Child's Age : (required)

Child's Grade Last Completed : (required)

Allergies/Medical Information/Other

Emergency Contact
Name : Phone :

Name : Phone :

Dismissal Information
Name(s) of person(s) who may pick up this child from VBS

Please note: There may be video or photo's taken of your child that may be posted on our social media sites.