VBS 2026 Registration Number of ChildrenUp to seven (7) can be registered at the same timeHow Many Children are You Registering?Parent/Guardian Contact InfoParent/Guardian First Name *Parent/Guardian Last Name *Phone *Parent/Guardian 2 First NameParent/Guardian 2 Last NamePhoneEmail AddressStreet Address *City *State/ProvinceEmergency ContactsPlease list at least one emergency contactName *Relation to childPhone *NameRelation to childPhonePick Up AuthorizationI hereby authorize the following people to pick up my child from LSCC's VBSNameRelation to childPhoneNameRelation to childPhoneChild InfoChild's Name *Child's Birth Date *GenderChooseBoyGirlGrade in School (This Next Year) *Choose GradeKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeMedical information we need to know. (Please include any food allergies.)Anything else we should know? Any restrictions in game participation?Second ChildSecond Child's Name *Second Child's Birth Date *GenderChooseBoyGirlGrade in School (This Next Year) *Choose GradeKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeMedical InformationOther InformationThird ChildThird Child's Name *Third Child's Birth Date *GenderChooseBoyGirlGrade in School (This Next Year) *Choose GradeKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeMedical InformationOther InformationFourth ChildFourth Child's Name *Fourth Child's Birth Date *GenderChooseBoyGirlGrade in School (This Next Year) *Choose GradeKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeMedical InformationOther InformationFifth ChildFifth Child's Name *Fifth Child's Birth Date *GenderChooseBoyGirlGrade in School (This Next Year) *Choose GradeKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeMedical InformationOther InformationSixth ChildSixth Child's Name *Sixth Child's Birth Date *GenderChooseBoyGirlGrade in School (This Next Year) *Choose GradeKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeMedical InformationOther InformationSeventh ChildSeventh Child's Name *Seventh Child's Birth Date *GenderChooseBoyGirlGrade in School (This Next Year) *Choose GradeKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeMedical InformationOther InformationMedical & Photo ReleasePhotography ReleaseYes, I give permission for my child/children's picture or video to be used in LSCC media.No, do not use any pictures or videos of my child/children in LSCC media.Medical Release *By checking this box, I hereby give permission for my child/children (as named in this form) to attend and participate in the LSCC VBS Program. I do herewith authorize emergency medical treatment be given if necessary, only after a reasonable effort has been made to reach me/us the parent(s) or guardian(s). I do hereby release and agree to hold harmless LSCC, its staff and leaders, from any liabilities or claims for personal injury or illness which may be incurred by my child while attending and participating in the VBS and its activitiesSubmit RegistrationPlease do not fill in this field.
