VBS 2021 Registration
Please fill out this form and click submit.
Child's Name
*
Parent/Guardian 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
Home/Cell Phone Number
*
Email
*
This address will receive a confirmation email
Child's birthdate
*
Child's last grade completed
*
Emergency Contacts (other than listed above)
*
Medical Information (any allergies/concerns)
*
Who may pick up your child at dismissal?
*
May we have permission to photograph your child?
*
Please select one option.
Yes
No
May we use your child's photograph for promotional purposes for VBS?
*
Please select one option.
Yes
No
Submit
Description
Please fill out this form and click submit.
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