VBS Child Registration 2025
Please fill out this form and click submit.
Child's Name
*
Parent/Guardian Name
*
Address
*
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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
Phone
*
Email
Date of Birth
*
Gender
*
Please select one option.
Male
Female
Select Option
Male
Female
Last Grade Completed
*
Please select one option.
5ys/not in kindergarten
K/1
2/3
4/5 grade completed
Select Option
5ys/not in kindergarten
K/1
2/3
4/5 grade completed
Allergies/Medical/Special Needs
Emergency Contact
Emergency Contact Phone Number
Authorized Pickup #1
*
Authorized Pickup #2
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
Submit
Description
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