Stellar VBS 2023 Registration Form "*" indicates required fields Child's Name:* First Last Child's Home Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Child's Birthday:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What grade is this child entering?*Select GradePreschool* (see disclaimer)Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th GradeI understand the preschool requirements.* Yes ***Disclaimer*** - Preschool Requirements & Limited Availability Our VBS is made available to all children entering grades K through 6th. We have limited availability for children in preschool. The current requirements are that the children have completed at least 1 year of preschool and are potty-trained. Once the preschool group has filled up we cannot accept any further signups due to maximum capacity of the space available. Who brings this child to VBS?*(check all that apply) Parent/Guardian 1 Parent/Guardian 2 Select AllParent/Guardian 1Name:* First Last Relationship to Child:* Phone:*Email: Use same address as child?* Yes No Parent/Guardian 1 Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Parent/Guardian 2Name:* First Last Relationship to Child:* Phone:*Email: Use same address as child?* Yes No Parent/Guardian 2 Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Please list all adults that this child may be release to:* Does this child have any allergies?* Yes No Please list all allergies:*Does this child have any medical concerns or special accomodations of any kind?* Yes No Please list any needs/accomidations:* Δ
