VBS 2009 Registration

Please register each child separately.

Your Child

First name: *

Please enter your child's first name.

Last name: *

Please enter your child's last name.

Age: *

Please enter your child's age (4 years through 6th grade).

Grade completed: *

Please enter the school grade your child will have completed by June of this year.

Allergies/Medical information:

Please list any allergies or medical information we should know about your child.

Parent/Guardian

Name: *

Please enter full name of the child's parent or guardian.

Phone number: *

Please enter phone number of the child's parent or guardian.

The remaining details are the same as the information for:

If the remaining details should be copied from a previous registration, enter that child's full name here. Otherwise, please enter the remaining details.

Address

Street address:

Please enter your street address.

City:

Please enter your city.

State:

Please select your state.

Zip code:

Please enter your zip code.

Emergency contact:

Please enter the individual we should contact—name and phone number—in the event of an emergency regarding your child.

Persons allowed to pick up child:

Enter the name(s) of the people allowed to pick up your child from VBS

Other:

If you choose "Other", please specify here.

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