Elementary VBS for Vol. Kids 2019

July 8-11 | Please fill out this form and click submit to register your child for childcare. One form must be completed per child.

Participant's Info:

This sections is about your child:

Name

*

Birthdate

*

Gender

*

Please select one option.

Male Female

Grade Entering

*

Please select one option.

Nursery 3's 4's/ Pre-K Kindergarten 1st 2nd 3rd 4th 5th

Address

*

Allergies or Special Needs?

*

Please select all that apply.

Yes No

If yes, please explain:

Willing to complete Medical/Photo Release?

*

Please select all that apply.

Yes No

Parent / Legal Guardian Info:

Guardian 1:

First Name

*

Last Name

*

Phone

*

Email

*

This address will receive a confirmation email

Relationship to participant

*

Guardian 2:

First Name

Last Name

Phone

Email

Relationship to participant

Alternate Pickup/ Emergency contact

First Name

*

Last Name

*

Phone Number

*

Email

Relationship to paricipant

*

Description

July 8-11

Please fill out this form and click submit to register your child for childcare. One form must be completed per child.

Please Fix the Following

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