Register for VBS

Family Information

Address

Primary Phone

Alternate Phone

Relationship to Student Father Mother Grandfather Grandmother Great-grandfather Great-grandmother Brother Sister Uncle Aunt Guardian Foster Parent Granduncle Grandaunt Other

Phone Number

Questions please contact Megan Amos (785-623-9753)

Student Information

Gender

Birth Date

Age Group

Food Allergies

Details

Medical Concerns

Details

Do we have permission to take and use pictures of your child? Yes No

I have more students to register