Elementary VBS Registration
AGES 5-12 Y.O. ONLY
Child's First Name
Child's Last Name
Child's Date of Birth
Parent or Guardian's name
Emergency Contact Name
Emergency Contact Number
Person (other than parent) allowed to pick up child
Does child have allergies? If yes, to what?
How did you hear about our VBS program?
Word of mouth (Friend/family member)
If other, please explain
Enter the numbers from the image:
174 Holmes Street, New Jersey, 07109, United States