VBS Online Registration

Child's Name (required)

Birth Date (required)

Last Grade Completed in School (required)

Address (required)

Mailing Address (if different)

Medical information that we may need to know (Please include any food allergies)

Parent/Guardian Name (required)

Home Phone (required)

Cell Phone (required)

Work Phone


Emergency Contacts (Other than listed above)
Name and Phone

Name and Phone

If your child is visiting, who is he/she a guest of?

May we have permission to photograph your child and use it for future promotion?