VBS STUDENT REGISTRATION

Please complete one form for each student attending.

PARENT/GUARDIAN NAME:

First Name

Last Name

PARENT/GUARADIAN EMAIL:

STREET ADDRESS

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

PARENT/GUARDIAN PHONE NUMBER:

(###)

###

####

EMERGENCY CONTACT

(other than guardian listed above)

First Name

Last Name

EMERGENCY CONTACT PHONE NUMBER:

(###)

###

####

STUDENT NAME:

First Name

Last Name

COMPLETED GRADE or AGE (AS OF JULY 1, 2024):

ALLERGIES OR ACCOMMODATION REQUESTED:

Please list any relevant allergies we should be aware of or any accommodations your student needs while attending VBS.