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Online Enrollment Form for VBS 2016

If you have more than one child, please complete this form once for EACH child.

Child's Name *
Child's Name
Parent / Guardian Name *
Parent / Guardian Name
Address
Address
Home Phone
Home Phone
Cell
Cell
Age Information
Date of Birth
Date of Birth
Allergies / Medical Information / Other Things we should know
Emergency Contacts – Where YOU can be reached DURING VBS hours
Contact 1 *
Contact 1
Contact 1 Phone *
Contact 1 Phone
Contact 2
Contact 2
Contact 2 Phone
Contact 2 Phone
Dismissal Information
Name(s) of person(s) authorized to pick up this child each day (include Parent/Guardian names)