VBS NIGHT CHILD REGISTRATION Child's Name * First Name Last Name Parent/Guardian Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Emergency Contact Phone (###) ### #### Allergies or Special Needs Age/Grade * 4 to 5 years old Entering 1st Grade Entering 2nd Grade Entering 3rd Grade Entering 4th Grade Entering 5th Grade Thank you!
