2025 VBS Registration

General Information

Child's Name:

Child's Gender:

Male Female

Date of Birth:

Age:

Parent/Guardian Information

Parent/Guardian's First and Last Name:

Home Address:

Primary Phone Number:

Secondary Phone Number:

Email:

This address will receive a confirmation email

Emergency Contact

Emergency Contact's First and Last Name:

Emergency Contact's Phone Number:

Important Questions

Is there a friend your child would like to be in the same group with?

Does your child have any special needs or allergies?

Is there any other information we should know, so we can care for your child better?

Pick Up Information

First and last name of the person picking up your child after VBS:

Their Phone Number:

Their relationship with your child:

Insurance Information

Insurance Company:

Insurance ID Number:

Insurance Group Number:

Volunteering for VBS

Are you interested in volunteering for VBS?

Yes No

Description

Please fill out this form and click submit. If you have any questions, please email office@dhefc.org or call 631-271-4422.