Preparing a Demo

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VBS Registration

Parent/Guardian Name *

Parent Email *

Parent Mobile Phone *

Parent Address *

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manageMemberFields.fields.ZipCode

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Would you like to add an additional Emergency Contact?

Yes

Emergency Contact — Full Name

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Emergency Contact — Relationship to child(ren)

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Emergency Contact — Phone

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Child Registration

Child 1 — First Name *

Child 1 — Last Name *

Child 1 — Gender *

Male

Female

Child 1 — Date of Birth *

Child 1 — Last Grade Completed *

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Child 1 — Does your child have any Medical or Allergy concerns you need to share? *

Yes

Child 1 — If yes, please describe medical or allergy concerns

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Child 1 — If your child has a developmental condition that requires assistance (e.g., not fully potty trained), can you or a caregiver attend VBS as well? *

We are unable to provide personal hygiene assistance, including changing diapers or pull-ups. If your child requires this level of care, a parent, guardian, or other caregiver will need to attend VBS as well.

Yes

Additional Child - 2

Yes

Child 2 — First Name

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Child 2 — Last Name

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Child 2 — Gender

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Child 2 — Date of Birth

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Child 2 — Last Grade Completed

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Child 2 — Does your child have any Medical or Allergy concerns you need to share?

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Child 2 — If yes, please describe medical or allergy concerns

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Child 2 — If your child has a developmental condition that requires assistance (e.g., not fully potty trained), can you or a caregiver attend VBS as well?

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Additional Child - 3

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Child 3 — First Name

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Child 3 — Last Name

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Child 3 — Gender

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Child 3 — Date of Birth

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Child 3 — Last Grade Completed

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Child 3 — Does your child have any Medical or Allergy concerns you need to share?

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Child 3 — If yes, please describe medical or allergy concerns

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Child 3 — If your child has a developmental condition that requires assistance (e.g., not fully potty trained), can you or a caregiver attend VBS as well?

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Additional Child - 4

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Child 4 — First Name

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Child 4 — Last Name

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Child 4 — Gender

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Child 4 — Date of Birth

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Child 4 — Last Grade Completed

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Child 4 — Does your child have any Medical or Allergy concerns you need to share?

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Child 4 — If yes, please describe medical or allergy concerns

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Child 4 — If your child has a developmental condition that requires assistance (e.g., not fully potty trained), can you or a caregiver attend VBS as well?

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Additional children (include name, birthdate, grade, allergies)

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How did you hear about VBS?

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Invited by - First Name

Invited by - Last Name

By checking below I confirm I am the parent/legal guardian and I agree to the photo release described above. *

I agree

Signature

Full Name *

Parent/Guardian Signature *common.clear

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