Child's Name * First Name Last Name Child's Birth Date * MM DD YYYY Grade Just Completed * Choose from Drop-Down List Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade Parent/Guardian's Name * First Name Last Name Phone * (###) ### #### Email * Mailing Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Allergies / Special Needs / Other Concerns * Emergency Contact Name * First Name Last Name Emergency Contact Phone * (###) ### #### Who Is Authorized to Pick Up Your Child from VBS? * First Name Last Name Thank you!
