VBS In the Park 2019 Registration
Please fill out this form and click submit.
Child's Name
*
Child's Age
*
School Grade Completed
*
Parent / Guardian Name
*
Parent / Guardian Phone Number
*
Parent / Guardian Alternate Phone Number
Home Address (in case of emergency)
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Emergency Contact Name
Emergency Contact Phone Numer
Please tell us any important information about your child including medical needs, allergies or special needs.
If you are registering sibilings, please tell us their names, ages, grades completed and any important informaiton
Drop Off & Pick Up Information
The safety of the children in our care is of utmost importance to us. We require that all parents/guardians come to our reigstration table and present a valid ID for pick up and drop off.
Person(s) apprved to pick up my child on Tuesday *valid ID required
*
Person(s) approved to pick up my child on Wednesday *valid ID required
*
Person(s) approved to pick up my child on Thursday *valid ID required
*
Submit
Description
Please fill out this form and click submit.
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