VBS Registration

Parents Names (required)

Parents Email (required)

Child's Name (required)

School Grade (required)

Mailing Address (required)

City (required)

Zip Code (required)

Primary Phone (required)

Secondary Phone (required)

Home Church (required)

Guest of

List adults who may pick up your child (required)

In case of emergency, contact one (required)

Phone one: (required)

In case of emergency, contact two (required)

Phone two: (required)

Allergies or other medical conditions (required)

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