VBS Registration 2024
June 3rd-6th (5:00 - 7:30 PM) | For kids preschool - completed 5th grade
Please use this form for up to three (3) children. A separate registration
form must be used for additional participants.
Participant #1
Participant Name
*
Age
*
Grade
*
T-Shirt Size
*
Please select one option.
Youth Extra Small
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
Select Option
Youth Extra Small
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
List all known allergies
*
Participant #2
Participant Name
Age
Grade
T-Shirt Size
Please select one option.
Youth Xtra Small
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
Select Option
Youth Xtra Small
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
List all known allergies
Participant #3
Participant Name
Age
Grade
T-Shirt Size
Please select one option.
Youth Extra Small
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
Select Option
Youth Extra Small
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
List all known allergies
Parent/Guardian Information
Parent/Guardian Name
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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IL
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ME
MH
MI
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MO
MP
MS
MT
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NE
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NJ
NL
NM
NS
NT
NU
NV
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Relationship
*
I give consent for my child(ren)s image to be published online and in print
*
Please select all that apply.
Yes
No
Payment
Suggested Donation (to help offset costs of supplies and dinner)
1 Child ($15)
2 Children ($30)
3 Children ($45)
Donation Waived ($0)
1 Child ($15)
2 Children ($30)
3 Children ($45)
Donation Waived ($0)
Amount
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
June 3rd-6th (5:00 - 7:30 PM)
For kids preschool - completed 5th grade
Please use this form for up to three (3) children. A separate registration
form must be used for additional participants.
×
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