FACC VBS Registration Form Child Name & Age* NAME (First & Last) AGE Parent/Guardian Name* FIRST LAST Phone* Email* 2nd Parent/Guardian Name FIRST LAST Phone Emergency Contact Name* FIRST LAST Phone* Relationship:* Who will attend?* Name Adult or Child Dietary Restrictions/Allergies or other Medical Conditions: Please list any other information you’d like to include about your child: Media Waiver* YES NO Do you allow us to take photos/ Video of your child or children?
