Child's Name
Parent / Guardian Information
Name
Mailing Address
Email
Phone Numbers
Home
Cell
Work
Child's Information
Children must have completed 3-year-old preschool to participate.
Date of Birth
Age
Last School Grade Completed
Allergies
Medical Information
Other
Emergency Contacts
Name
Phone
Name
Phone
Dismissal Information
Name(s) of person(s) who may pick up this child from VBS: