Child's Name
Child's Grade
(This Fall)
Child's Age
Parents/Guardians
Street address
City
Zip Code
Email
Cell Phones #'s
Home Phone
Authorized pickup:
Please list anyone who may be picking up your child from VBS
Include NAME --- RELATIONSHIP --- PHONE #
Please enter the validation text above
Please indicate any alergies or special needs your child may have
Parent/Guardian #1
Parent/Guardian #2
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