LS VBS
Child's Name
*
Child's Age
*
Grade during Upcoming School Year (2018-2019)
*
Preschool
Kindergarten
First
Second
Third
Fourth
Fifth
Sixth
Birthdate
*
Address
*
City
*
State
*
MO
KS
----
Zip
*
Name of Parent/Guardian
*
Phone Number
*
Email
*
Emergency Contact and Number
*
Allergies/Health Concerns
*
People Authorized to Pick Child Up
T-Shirt Size ($6.00)
Youth Extra Small (2-4)
Youth Small (6-8)
Youth Medium (10-12)
Youth Large (14-16)
Music CD ($7.00)
1
2
None
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