VBS Participant Registration 2024
Please fill out this form and click submit.
Parent Information
Parent Name
*
Email
*
This address will receive a confirmation email
Phone
*
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
Emergency Contact/Alternate Pickups
Emergency Contact Name
*
Emergency Contact Phone
*
Alternate Pickup Name
*
Alternate Pickup Phone
*
Alternate Pickup 2 Name
Alternate Pickup 2 Phone
Child Information
Child's Last Name
*
Child's First Name
*
Gender
*
Date of Birth
*
Grade Finished
*
Please select one option.
PreSchool
Kindergarten
1st
2nd
3rd
4th
5th
Allergies
*
Medical Issues
*
Extra Information
Does your child have a friend they would like to be placed with? If so who?
Please include anything else you would like us to know in order to ensure your child has an amazing week?
Submit
Description
Please fill out this form and click submit.
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