REGISTER HERE FOR VBS 2023

Child Information (Adults with no children may register by filling out the Parent Information Section only)

First Name

Last Name

Age

Grade

Parent / Guardian Information / Adult (18 years and older)

First Name

Last Name

Parent / Guardian Phone

(###)

###

####

Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child's Allergies

Medications

Additional Information

Please provide us with any additional information we may need to know concerning your child(ren).

Emergency Contact Name

Emergency Contact Phone

(###)

###

####

Authorized Pick-up Individuals

Please indicate who is authorized by you to pick up your child.

Media Permission

Please indicate if you authorize your child to be photographed and those photos be posted on our SBC website or newsletter

Yes

No