Otterbein VBS Registration

June 21-25, 2021, following recommended Covid-19 guidelines

Parent Name*

First

Last

Child Name*

First

Last

Address

Street Address City State / Province Postal / Zip Code

Phone

Emergency Phone

Email Address

I would like to help

OK to photograph

Child Age*

Birthdate (Example: May 6, 2013)

Grade last completed (Kindergarten = 0, Leave blank for younger children)

Allergies

Comment (Additional information for the VBS coordinator)

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