vbs-2023-registration Please enable JavaScript in your browser to complete this form.Child's Name *FirstLastParent's Name *FirstLastPhone *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *----------------------------------------------------Gradepre-schoolKindergarten FristSecondThirdForthFifthAge3456789101112----------------------------------------------------Emergency Contact *FirstLastEmergency Contact Phone *----------------------------------------------------Person responsible for child pickup. (if different from parent)FirstLastPhoneRelationship to Child---------------------------------------------------- Click here to order a VBS T-Shirt Special Request or Information----------------------------------------------------In case of an emergency, I give my permission to the staff to secure needed emergency medical/dental care, if a parent/guardian cannot be immediately contacted. YesPhoto Release Consent: I hereby allow the reproduction and publication of my child's photograph(s) *YesSubmit
740-845-0154
