VBS RegristrationMay 22-26, 2023 Name * First Name Last Name Email * Phone * (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Birth Date * Last Grade Completed * Medical Information Please provide any medical or special needs details we need to know. List any Food Allergies List all people who may pick up your child * Does your child attend church? If so, where? Is your child a guest of someone? Who? Do we have permission to photograph your child? * Yes No Do we have permission to use your child's photo for promotional purposes? * Yes No Thank you!