Victory Life Church VBS
Student Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Student Age
5
6
7
8
9
10
11
12
13
14
15
Student Grade
Not in School
Pre-K
Kindergarden
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
Parent/Guardian Name
First Name
Last Name
Address (if different than Student)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Emergency Contact
First Name
Last Name
Emergency Contact Phone
-
Area Code
Phone Number
Relationship to Student
Name(s) of person(s) allowed to pick up student.
Current Medications
Student Allergies
Submit
Should be Empty: