Child's First Name

Child's Last Name

Gender

Date of Birth

School Grade entering in the fall of 2025: (ages 3 yr old - 5th grade)

Allergies

Child shirt size: (to guarantee a T-shirt, please register by July 1st)

Is there a friend with whom your child would like to be grouped with? If yes, please give friends first and last name: (We will accommodate this to the best of our abilities. Please note that we separate Kindergarten and younger from the older kids in groups. That way the activities are more on their understanding level.)

Medical Concerns:

Additional Parental Comments:

Parent First Name:

Parent Last Name:

Cell Phone

Email Address

Mailing Address

Mailing City

Mailing State

Zip Code

Emergency Contact Name:

Emergency Contact Phone:

Relationship:

Alternate Pickup Phone:

Name:

How did you hear about VBS?