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? * Yes No If a cell phone, can you receive text messages? Yes No Child's Full Name * Child's Gender * Female Male Child's Age (as of 6/22) * 3 and potty-trained 4 5 6 7 8 9 10 11 12 Other Grade your child is entering * Preschool Kindergarten 1st 2nd 3rd 4th 5th 6th Other 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.