Hero Central

2017 VBS Registration Form

June 19-22 from 9 to Noon

Child's Name:

Parent/Guardian Name:

Email Address:

Phone Numbers:
Home:
Cell:

Child's Date of Birth:

2017-2018 Grade Level:

Allergies/Medical Information:

Please provide any special instructions for your child:

Emergency Contacts:
Name: Phone:
Name: Phone:

Name(s) of person(s) who may pick up this child from VBS:

T-Shirt Size: