Parent or Guardian Name *
Parent or Guardian Name
Alternative Emergency Contact
Alternative Emergency Contact
Family Doctor
Family Doctor
Child's Name #1
Child's Name #1
Child's Name #2
Child's Name #2
Child's Name #3
Child's Name #3
Child's Name #4
Child's Name #4
Media Consent:
Please Add Me To The Children's Mailing List
Music CD $2
Payment due upon pickup at VBS
Children's T-Shirts Cost: $5
Payment due upon pickup at VBS