VBS Registration

Ages 3 (potty trained) -5^th Grade

Child's Name*
Address*
Street Address City State ZIP Code
Age*
Birthdate*
Date Format: MM slash DD slash YYYY
Last Grade Completed*
Parent/ Guardian Contact Information
Home Phone
Mobile Phone
Email*
Emergency Contacts:
Full Name*
Phone Number*
Full Name*
Phone Number*
Names of Persons with Permission to Pick up this child from VBS:
Full Name
Relationship
Full Name
Relationship
Allergies/Medical information/Food Needs/Other Concerns
Permission*
- I give my permission to allow photography of my child to be used on St. James website.
Parent/ Guardian*