VBS_Registration Registration Form (One Per Child) Please enable JavaScript in your browser to complete this form.Child's Name *FirstLastChild's GenderMaleFemaleopt outChild AgeChild DOBLast school grade completedName of Parent(s)Street AddressCityStateZip CodeHome telephone (include area code)Parent/Caregiver's cellphone.Home email addressHome churchList any allergies, medical conditions, or special needs of your childIn case of emergency: contact name & phone numberEmergency contact relationship to childSubmit
