VBS Volunteer Registration VBS 2022 Volunteer Registration June 6-10 // 9am - 12pm Name Volunteer Information Are you an Adult or Student? * AdultStudent Child 1 Information Last Name * Address * City * State * Zip Code * Gender * Male Female Date of Birth * Grade Entering Fall 2022 * PreK Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade If interested, please list ONE child in the SAME grade with whom your child would like to be placed (due to group size, not all requests will be granted). Additional Comments Medical Information Does your child have food allergies? * YesNo Does your child have any medical needs? * YesNo Emergency Contact Information Emergency Contact Person * Please give us the name of someone we can contact if you cannot be reached Emergency Contact Phone Number * Emergency Contact Relationship * Media Release Signature * Child 2 Information First Name * Last Name * Address * City * State * Zip Code * Gender * Male Female Date of Birth * Grade Entering Fall 2022 * PreK Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade If interested, please list ONE child in the SAME grade with whom your child would like to be placed (due to group size, not all requests will be granted). Additional Comments Medical Information Does your child have food allergies? * YesNo Does your child have any medical needs? * YesNo Emergency Contact Information Emergency Contact Person * Please give us the name of someone we can contact if you cannot be reached Emergency Contact Phone Number * Emergency Contact Relationship * Media Release Signature * Child 3 Information First Name * Last Name * Address * City * State * Zip Code * Gender * Male Female Date of Birth * Grade Entering Fall 2022 * PreK Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade If interested, please list ONE child in the SAME grade with whom your child would like to be placed (due to group size, not all requests will be granted). Additional Comments Medical Information Does your child have food allergies? * YesNo Does your child have any medical needs? * YesNo Emergency Contact Information Emergency Contact Person * Please give us the name of someone we can contact if you cannot be reached Emergency Contact Phone Number * Emergency Contact Relationship * Media Release Signature * Child 4 Information First Name * Last Name * Address * City * State * Zip Code * Gender * Male Female Date of Birth * Grade Entering Fall 2022 * PreK Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade If interested, please list ONE child in the SAME grade with whom your child would like to be placed (due to group size, not all requests will be granted). Additional Comments Medical Information Does your child have food allergies? * YesNo Does your child have any medical needs? * YesNo Emergency Contact Information Emergency Contact Person * Please give us the name of someone we can contact if you cannot be reached Emergency Contact Phone Number * Emergency Contact Relationship * Media Release Signature * Child 5 Information First Name * Last Name * Address * City * State * Zip Code * Gender * Male Female Date of Birth * Grade Entering Fall 2022 * PreK Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade If interested, please list ONE child in the SAME grade with whom your child would like to be placed (due to group size, not all requests will be granted). Additional Comments Medical Information Does your child have food allergies? * YesNo Does your child have any medical needs? * YesNo Emergency Contact Information Emergency Contact Person * Please give us the name of someone we can contact if you cannot be reached Emergency Contact Phone Number * Emergency Contact Relationship * Media Release Signature *
