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Registration Form

July 17-21, 9AM-NOON

Parent Name *
Parent Name
Cell/Primary Phone *
Cell/Primary Phone
This number will be used in the daily self check-in process. It will also be the first number called in the event of an emergency.
Address *
Address
Alternate Emergency Contact *
Alternate Emergency Contact
In the event of an emergency, we will first call the Cell/Primary phone number. Please provide an alternate emergency contact to be used in the event we are unable to reach the parent.
Alternate Emergency Contact Phone Number *
Alternate Emergency Contact Phone Number
Are you interested in volunteering for VBS?
If you check yes, someone from Warm Beach Kids' Team will contact you soon.
Child 1
Child's Name *
Child's Name
Birthday
Birthday
Child 2
Child's Name
Child's Name
Birthday
Birthday
Child 3
Child's Name
Child's Name
Birthday
Birthday