VBS 2009 Registration
Note: If the email "SEND" fails, you can cut and paste this FORM into your email personal email setup.
For questions, please call the EUM office at 618-263-6561
VBS 2009 Child Registration
Children's Information:
Last Name First name M/F D-O-B Age Grade Entering
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Do any of your children have any allergies, medical conditions, or concerns that we should be
aware of?
Contact Information:
Parent/Guardian . . :
Children's Address. :
Home Phone . . . . . :
Cell Phone. . . . . . . :
Email Address . . . . :
Additional Emergency Contact Information:
Name. :
Number:
Name. :
Number:
In the event of an emergency, I authorized first aid and/or other medical treatment for these children
and I release EUM any and all responsibility.
Print Authorizing Name. :
Relationship to Child . . :
Date . . . . . . . . . . . . . . . :