VBS 2021 Register below today! Child's InformationChild's Name* First Middle Last Gender*MaleFemaleGrade (2021-2022 School Year)*Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th GradeFood Allergies?*NoYesList Food AllergiesMedical Concerns?*NoYesExplain Medical ConcernsParent / Guardian's InformationParent/Guardian's Name* First Last Address* Street Address City State ZIP Cell Phone*Email Address* Emergency Contact Phone*Relationship to Child*MotherFatherExtended FamilyLegal GuardianCOVID Safety ProtocolWe would kindly ask you to keep your child home if: In the past 24 hours, your child has experienced one of the following new symptoms - fever of 100 degrees or greater, new onset cough, shortness of breath/difficulty breathing, new loss of smell or taste?; In the past 24 hours, your child has experienced any of the following new symptoms (unrelated to allergies or preexisting conditions) - chills, fatigue, muscle aches, headache, sore throat, nausea/vomiting, diarrhea, runny nose/congestion?; You are being tested for COVID-19 due to COVID-19 symptoms or travel. A person awaiting PCR test results for the above reasons needs to quarantine until their negative results are back.Please read the above and check below to finish I have read and agree to the above COVID safety protocol statement How did you hear about our VBS? Facebook Word-of-Mouth Post Card Brighton Buzz Redeemer Website Outdoor Sign Other Thanks!NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.