Child registration

Please complete all sections. A photo taken at registration helps us recognize your child at check-in.

Child

Child photo

Use your device camera. The photo is stored securely for identification during VBS.

Child’s full name

Child’s age

Date of birth

Grade completed

Gender

FemaleMale

Parent / guardian name

Phone number

Email address

Home address

Emergency contact name

Emergency contact phone

Relationship to child

Does your child have any allergies?

Does your child have any medical conditions we should know about?

Is your child taking any medication?

Special needs or accommodations?

Who is authorized to pick up your child?

May your child receive snacks?

YesNo