VBS 2017 Child's first name * Child's last name * Address * City * State * Zip Code * Phone Best number to reach you. Birth date * School grade just completed * Mother / Guardian's name Mother / Gaurdian's cell or best contact phone Father / Gaurdian's name Father / Guardian's cell or best contact phone Emergency Contact person, their relationship to you (mother, sister, etc.) and the phone number. Tell us who we should contact if there is an injury and we cannot reach you. Do you attend a church regularly? If so, what church? Any allergies or conditions we should be aware of concerning your child's care? Examples: peanut allergy, downs syndrome, deaf, prone to seizures, etc. Let us know if you need to talk to us further about your child. Register my child!