"In the Wild" VBS Registration Form
June 7 (6-8pm), June 8 (4-6pm), June 9 (4-6pm) | Please fill out this form and click submit.
Child's Name
*
Grade Completed
*
Age
*
Home 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
Parents' Names
*
Phone
*
Email
*
This address will receive a confirmation email
Emergency Contact Person
*
Relationship to Child
*
Phone
*
Does your child have food allergies? If so, list them. If not, type N/A.
*
List any medical concerns that you may have. If none, type N/A.
*
Number Attending
*
Can your child be in VBS photos and/or videos?
*
Please select one option.
Yes
No
Parent's Signature
*
Submit
Description
June 7 (6-8pm), June 8 (4-6pm), June 9 (4-6pm)
Please fill out this form and click submit.
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