VBS REGISTRATION

Parent/Guardian Full Name *
Address *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Email *
Please confirm email address *
Phone # *
Is this a cell phone? *
If a cell phone, can you receive text messages?
Child's Full Name *
Child's Gender *
Child's Age (as of 6/22) *
Grade your child is entering *
Please share important information regarding your child (medications, allergies, etc.)
Emergency Contact Full Name
Emergency Contact Phone #
Alternate Child Pickup
Alternate Child Pickup Phone #
Alternate Child Pickup 2
Alternate Child Pickup 2 Phone #
Friend/sibling your child would prefer to be placed with? Please provide name and age:
Additional Comments

    To register additional children, you will be returned to this
    page after clicking Register.