Name of Child *

First Name

Last Name

Last Grade Completed *

1-2 grade

3-4 grade

5-6 grade

Last Grade Completed

1-2

3-4

5-6

Parent Name *

First Name

Last Name

Parent Phone Number *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Checkbox *

Photos allowed on Social Media

yes

no

Checkbox *

Adult Class offered during VBS. Food will be served for attending adults. Please indicate if you will be attending.

No

Yes-1 Adult

Yes-2 adults

Yes-More than 2