PROOF PIRATES VBS REGISTRATION

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
We currently have spaces available for rising 4th-5th grade. Unfortunately, all of our PreK, Kindergarten and grades 1-3 classes are FULL. We apologize for the inconvenience but we want to keep all our VBS kids happy and safe. We hope to see you next year!

Names, Birthdates, and Ages of Children
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
NAME
BIRTHDATE (M/D/YYYY)
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
Should be Empty: