2018 VBS Registration
June 18-22, 6:00pm-8:30pm | Please fill out this form and click submit.
Child's Full Name:
*
Parent/Guardian Full Name:
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Child's Birthday (MM/DD/YYYY)
*
Home Phone:
*
Cell Phone:
*
Emergency Contact Name:
*
Emergency Contact Phone:
*
Email:
*
This address will receive a confirmation email
Grade Completed by June:
*
Please select one option.
Pre-K
K
1
2
3
4
5
6
Select Option
Pre-K
K
1
2
3
4
5
6
Medical Information:
Any medical information we need to know. (please include food allergies)
*
Who invited you to VBS this year:
Submit
Description
June 18-22, 6:00pm-8:30pm
Please fill out this form and click submit.
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