PROOF PIRATES VBS REGISTRATION
Parent/Guardian’s Name (Last, First)
Please list all adults permitted to pick up children
Contact Phone
Street Address
Street Address
Names, Birthdates, and Ages of Children
Select the grade your child most recently completed then write their name and birthdate. Must be 3 and FULLY potty trained. Please make sure your little one is comfortable with a crowd as we expect at least 75 students will attend.
Preschool
Select the grade your child most recently completed then write their name and birthdate
Kindergarten
Select the grade your child most recently completed then write their name and birthdate
Grade 1
Select the grade your child most recently completed then write their name and birthdate
Grade 2
Select the grade your child most recently completed then write their name and birthdate
Grade 3
Select the grade your child most recently completed then write their name and birthdate
Grade 4
Select the grade your child most recently completed then write their name and birthdate
Grade 5
NAME
BIRTHDATE (M/D/YYYY)
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
List any allergies
Emergency Contact Name
Emergency Contact Phone
Are we permitted to take pictures of your child?
Yes
Are we permitted to take pictures of your child?
No
Preview PDF
Submit
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