Child 1

Child's Name: (1)
Birthday: (1)
Age/Grade: (1)
Last grade completed (1):

Child 2

Child's Name: (2)
Birthday: (2)
Age/Grade: (2)
Last grade completed (2):

Child 3

Child's Name: (3)
Birthday: (3)
Age/Grade: (3)
Last grade completed (3):

Parent/Guardian Name:
Relationship:
Please list any friends or relatives who have your permission to pick up your child:
Address:
Phone:
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Cell Phone:
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Secondary Phone:
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E-mail:
Please list any allergies, physical limitations, special needs or sensory issues:
Please tell us how you heard about VBS?
Would you like to receive information about future children's activities?