Simple Event Registration Form

VBS 2016 Registration

Fill out the form to register your child for VBS.
Child's Name *

First Name Last Name
Parent/ Guardian's Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Primary Phone *
Secondary Phone
E-mail *
Medical Information
Medications, Allerigies, etc.
Emergency Contacts (other than listed above)
Name
Phone
Name
Phone
Dismissal Information *
Who may pick up your child at the end of each VBS day?
Visiting?
Is your child visiting or a regular at CCO?
May we photograph your child? *

Yes No
Should be Empty:

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