2017 VBS Sign Up Thank you for trusting us with your family and signing up for VBS! Please complete the form below to register. Answering the questions as fully as possible will allow us to plan a fun and safe VBS for your child(ren)! If you have multiple children to register, please re-submit this form for each additional child. We apologize for any inconvenience. Child's InformationChild's Name* Child's First Name Child's Last Name Child's Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Child's GradeEntering KindergartenEntering First GradeEntering Second GradeEntering Third GradeEntering Fourth GradeEntering Fifth GradeEntering Sixth GradeChild's GenderMaleFemaleChild has friend to be placed with?Does this child have a friend the he/she would like to be placed with?Child's Allergies*Does this child have any allergies to food, medicine or the environment? If none, please enter "None."Child's Medical Information*Does this child have any medical conditions, medical history, or take any medications everyday? If none, please enter "None."Photography ReleaseNo. Not OK to photograph.Yes. Ok to photograph.By checking "Yes", I give permission for EBC to photograph my child/children for daily VBS Photo Slideshows and any other promotion related to VBS/EBC. EBC will never sell the photographs or use the images for any other purpose other than VBS related promotion and events.Parent InfomationParent Name* Parent's First Name Parent's Last Name Parent Email* Enter Email Confirm Email We will only use this email address to communicate information about VBS related events. We will never give your email address to anyone.Primary Phone Number*Primary Phone Type*Cell PhoneHome PhoneWork PhoneSecondary Phone NumberSecondary Phone TypeCell PhoneHome PhoneWork PhoneI would like to purchase a VBS Music CD for $5.00.No. I do not want to purchase a CD.Yes. I do want to purchase a CD.I already checked Yes under another registration.If you would like, you can purchase a CD of the VBS Music to enjoy at home. The cost of this CD is $5.00.Thank you for purchasing a music CD! Please bring $5.00 with you to Day 1 of VBS.Are you part of the VBS Volunteer Team?No. I'm not a volunteer.Yes. I'm a volunteer.Nursery or Pre-K Child?NurseryPre-KIf needed, child care is offered for the VBS Volunteer Team. Please enter the age bracket.