VBS Registration Page

|||

Facebook Instagram YouTube Phone Email

VBS Registration Form
- The maximum number of form submissions has been reached. This form is currently not available.
  
  Head of Household Information
  
  Mother's Name Please enter valid data.
  
  Mother's Cell Number Maximum 20 characters Please enter a phone number.
  
  Father's Name Please enter valid data.
  
  Father's Cell Number Maximum 20 characters Please enter a phone number.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Alternate pick up buddy
  
  Name of people (other than parents) authorized to pick up child and relationship to child: Please enter valid data.
  
  Emergency Information
  
  Emergency Contact Name & Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Doctor/Clinic Name & Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Preferred Hospital REQUIRED Please fill out this field. Please enter valid data.
  
  Child/Children Attending
  
  Number of Campers REQUIRED Please fill out this field.
  
  Camper's Name 1
  
  Registration Fee60.0
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Male/Female REQUIRED Please fill out this field.
  
  2025-26 Grade Level REQUIRED Please fill out this field. Please enter valid data.
  
  Child's special needs.
  
  Child's allergies.
  
  Camper's Name 2
  
  Registration Fee60.0
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Male/Female REQUIRED Please fill out this field.
  
  2025-26 Grade Level REQUIRED Please fill out this field. Please enter valid data.
  
  Child's special needs.
  
  Child's allergies.
  
  Camper's Name 3
  
  Registration Fee60.0
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Male/Female REQUIRED Please fill out this field.
  
  2025-26 Grade Level REQUIRED Please fill out this field. Please enter valid data.
  
  Child's special needs.
  
  Child's allergies.
  
  Camper's Name 4
  
  Registration Fee60.0
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Male/Female REQUIRED Please fill out this field.
  
  2025-26 Grade Level REQUIRED Please fill out this field. Please enter valid data.
  
  Child's special needs.
  
  Child's allergies.
  
  Camper's Name 5
  
  Registration Fee60.0
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Male/Female REQUIRED Please fill out this field.
  
  2025-26 Grade Level REQUIRED Please fill out this field. Please enter valid data.
  
  Child's special needs.
  
  Child's allergies.
  
  Music Preference
  
  Choose one: CD Download link to the music videos and songs
  
  Waivers & Releases
  
  Parent or Guardian Full Name: By signing below, I verify that I am the legal guardian or parent of all minors named on this form. REQUIRED Please fill out this field. Please enter valid data.
  
  Electronic Signature Consent REQUIRED
  If you request paper forms, you must type "paper" in ALL Signature boxes before submitting this form.
  I consent to signing electronically I request paper forms (Type "paper" in ALL signature boxes below) Please fill out this field.
  
  MEDICAL RELEASE
  
  Please reveiw the medical release form and sign below.
  
  Parent/Guardian Electronic Signature for Medical Release REQUIRED
  NOTE: Type "PAPER" if you have requested paper forms. If you do not agree to the medical release, type "DO NOT CONSENT".
  Please fill out this field. Please enter valid data.
  
  AUTHORIZATION, CONSENT AND RELEASE FOR USE OF VISUAL LIKENESSES AND ORIGINAL WORKS OF MINORS
  
  Please review the policy outlining the use of visual likenesses & original works of minors.
  
  Parent/Guardian Electronic Signature for Release of Likeness and Artwork REQUIRED
  NOTE: Type "PAPER" if you have requested paper forms. If declining consent, enter "DO NOT CONSENT".
  Please fill out this field. Please enter valid data.
  
  Release of Likeness and Artwork REQUIRED Yes No Please fill out this field.
  
  Fee Summary
  
  Would you like to add 3.1% to cover the cost of credit card processing? REQUIRED Yes No Please fill out this field.
  
  Total:
  
  Submit
  
  Proceed to Payment