Events 2018 VBS Registration formStudent's Name *FirstLastParent/Family/Guardian Name *FirstLastAddress *Home PhoneHome phone, including area codeWork PhoneWork phone, including area codeCell PhoneCell phone, including area codeEmail *Dismissal Info *Name(s) of person(s) who may pick up this child from VBSStudent's Date of Birth *Last School Grade Completed *Home ChurchFriends of your child at WNUMC (if any)Special Needs/Allergies/Medical Information/Other: *Required; if none, please enter "none"Emergency Contact *Name and phone number of emergency contactPermission to take child's photo? *YesNoEmailSubmit
