2022 VBS Registration - Kookaburra Coast | Aug 22-26 | 6:00-7:30 PM
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Grade going into in the Fall
*
Please select one option.
Pre 4
K5
1st
2nd
3rd
4th
5th
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Pre 4
K5
1st
2nd
3rd
4th
5th
Child's name (each child must have his/her own registration)
*
Gender
*
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Boy
Girl
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Boy
Girl
Address, City/Town, State & Zip Code
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Birthdate (M/D/Y)
*
Phone (best number to reach you)
*
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Home
Work
Cell
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Home
Work
Cell
Email
*
This address will receive a confirmation email
Parent/Guardian
*
Child brought by
*
Allergies
*
Please select one option.
None
Peanuts
Seafood
Asthma
Seasonal
Other - please list
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None
Peanuts
Seafood
Asthma
Seasonal
Other - please list
Other helpful information
*
Please tell us how your heard about VBS
*
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from a friend
Facebook Ad
Drive by/ Banner
Celebrate West Hartford Days
Returning attendee
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from a friend
Facebook Ad
Drive by/ Banner
Celebrate West Hartford Days
Returning attendee
Church (optional)
*
Submit
Description
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