Registration

 

Student’s Name

Parent/Family/Guardian Name

Address

E-mail Address

Phone Numbers:
Home

Cell

Work

Date of birth

Age

Last school grade completed

Home church

Allergies/Medical Information/Other

Emergency Contacts:
Name

Phone

Name

Phone

Dismissal Information?:
Name(s) of person(s) who may pick up this child from VBS

Anything else you would like us to know about your child?

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