2019 VBS Registration - Giddyup Junction
August 12-16, 2019 9:30a-Noon | Please fill out this form and click submit.
Grade child is going into in the Fall
Grade
*
Please select one option.
K4 - K5
1st
2nd
3rd
4th
5th
6th
Select Option
K4 - K5
1st
2nd
3rd
4th
5th
6th
Child's name (each child must have his / her own registration)
*
Gender
*
Please select one option.
Boy
Girl
Select Option
Boy
Girl
Birthdate (M/D/Y)
*
Address
Address
*
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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
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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
Cell Phone
*
Email
*
This address will receive a confirmation email
Parent/Guardian
*
Child brought by
Allergies
Please list or "none"
*
Other helpful information
Please tell us how you heard about VBS
Please select all that apply.
From a friend
Facebook ad
Drive by / banner
Celebrate West Hartford Booth
Returning attendee
Church (Optional)
Other
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Name
*
Submit
Description
August 12-16, 2019 9:30a-Noon
Please fill out this form and click submit.
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