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VBS Registration Form, June 16-20, 2014
By registering your child, you are agreeing to photo opportunities that may be published.
Parent's Name
Address
Phone Numbers
E-mail Address
Person picking child up if not parent
Emergency Phone Number
On this form you can register up to 5 children. If you have additional children to register, you will need to submit an additional form.
Child #1
Child's Name
Age
Grade (just finished)
Birthday
Medical Conditions or Allergies
Child #2
Child's Name
Age
Grade (just finished)
Birthday
Medical Conditions or Allergies
Child #3
Child's Name
Age
Grade (just finished)
Birthday
Medical Conditions or Allergies
Child #4
Child's Name
Age
Grade (just finished)
Birthday
Medical Conditions or Allergies
Child #5
Child's Name
Age
Grade (just finished)
Birthday
Medical Conditions or Allergies
Please note, there is a light show, and if this will affect your child in any way please let us know (jrtravis2001@yahoo.com).
Thank-you for registering your child! Press the Submit button to submit your registration.