VBS Online Registration

Child's Name (required)

Birth Date (required)

Last Grade Completed in School (required)

Address, City, State & Zip(required)

Mailing Address (if different)

Food Allergies / Special Needs (If none, write "none")

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?