On-Site or At-Home Backyard BOLT VBS Registration, August 18-20, 2020
August 18-20, 2020 | Please fill out this form and click submit.
Child's Name (please complete one form for each child you are registering):
*
Gender
*
Please select one option.
Male
Female
Address
*
--
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
Parents/Guardian
*
Email
*
This address will receive a confirmation email
Cell Phone
*
Please select the age group that applies to this your child:ge groups:
*
Please select one option.
Completed kindergarten - 1st grade
Completed 2nd - 3rd grade
Completed 4th - 6th grade
Please select which session you would like to participate in:
*
Please select one option.
Morning session, 10am-12pm
Evening session, 6-8pm
At-Home Option (will include a family take home packet with supplies)
List names and phone numbers of other adults authorized to drop off/pick-up your child (ON-SITE only)
Emergency Contact & Relationship to Child (ON-SITE only)
Emergency Contact Phone (ON-SITE only)
Special Needs: (learning, behavior, diet, medical, allergies) What can we do to help with these needs?
*
Please select all that apply.
Yes
No
N/A - We will participate at home only.
If Yes to above, please about these special needs:
I agree that I will complete the required liability waiver form prior to my child's participation, if I have not already done so, (updated in June 2020 so all must sign the new version).
*
Please select one option.
Yes
No
N/A - We will participate at home only.
Submit
Description
August 18-20, 2020
Please fill out this form and click submit.
×
Please Fix the Following