VBS Child Registration 2024

Please fill out this form and click submit.

Child's Name

*

Parent/Guardian Name

*

Address

*

Phone

*

Email

Date of Birth

*

Gender

*

Please select one option.

Male Female

Last Grade Completed

*

Please select one option.

4 yrs 5ys/not in kindergarten K/1 2/3 4/5/6

Allergies/Medical/Special Needs

Emergency Contact

Emergency Contact Phone Number

Authorized Pickup #1

*

Authorized Pickup #2

T-shirt Size

*

Please select one option.

Child's X-Small Child's Small Child's Medium Child's Large Child's X-Large Adult Small Adult Medium Adult Large

I give permission to take photographs and / or video of my child. I grant full rights to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images for fundraising, publicity or other purposes to help achieve the LSBC's aims.

Please select one option.

Yes No

Description

Please fill out this form and click submit.

Please Fix the Following

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