VBS registration

Parent/Guardian

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Email REQUIRED Please fill out this field. Please enter an email address.
Address REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Phone Number REQUIRED Please fill out this field. Please enter a phone number.
Phone #2 Please enter a phone number.

In an EMERGENCY, and unable to reach parent/guardian numbers above, contact:

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Number of children attending REQUIRED Please fill out this field.
Child 1
- Name REQUIRED Please fill out this field. Please enter valid data.
- 2021/22 Grade REQUIRED Please fill out this field.
- Sex REQUIRED Male Female Please fill out this field.
- Birthday REQUIRED Please fill out this field. Please enter a date.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Tshirt Size REQUIRED Please fill out this field.
- ALLERGIC REACTIONS/MEDICAL CONDITIONS we should be aware of:
- Buddy Request (we'll try to accommodate requests for one friend to be with) Please enter valid data.
Child 2
- Name REQUIRED Please fill out this field. Please enter valid data.
- 2021/22 Grade REQUIRED Please fill out this field.
- Sex REQUIRED Male Female Please fill out this field.
- Birthday REQUIRED Please fill out this field. Please enter a date.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Tshirt Size REQUIRED Please fill out this field.
- ALLERGIC REACTIONS/MEDICAL CONDITIONS we should be aware of:
- Buddy Request (we'll try to accommodate requests for one friend to be with) Please enter valid data.
Child 3
- Name REQUIRED Please fill out this field. Please enter valid data.
- 2021/22 Grade REQUIRED Please fill out this field.
- Sex REQUIRED Male Female Please fill out this field.
- Birthday REQUIRED Please fill out this field. Please enter a date.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Tshirt Size REQUIRED Please fill out this field.
- ALLERGIC REACTIONS/MEDICAL CONDITIONS we should be aware of:
- Buddy Request (we'll try to accommodate requests for one friend to be with) Please enter valid data.
Child 4
- Name REQUIRED Please fill out this field. Please enter valid data.
- 2021/22 Grade REQUIRED Please fill out this field.
- Sex REQUIRED Male Female Please fill out this field.
- Birthday REQUIRED Please fill out this field. Please enter a date.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Tshirt Size REQUIRED Please fill out this field.
- ALLERGIC REACTIONS/MEDICAL CONDITIONS we should be aware of:
- Buddy Request (we'll try to accommodate requests for one friend to be with) Please enter valid data.

TOTAL PAID (payment required through Online Giving - Faith Formation) REQUIRED 1 Child - $25 2 Children - $50 3 Children - $75 4 Children - $100 Parent/Guardian is a VBS volunteer Please fill out this field.