Enter Child's Full Name
First Name
Middle
Last Name
Email Address for Parent*
PO Box
Address *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Phone 1 (Emergency)*
Phone 2
Please list your child's food allergies and/or medical conditions:
Please Select Grade Completed *
By completing this registration, I also grant the YTBC VBS leaders permission to photograph/video the minor listed above for any lawful purpose associated with this VBS program.