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VBS Jungle Safari Registration 2014
If you are human, leave this field blank.
Register as a
*
Child
Adult
Volunteer
Donor
A $20 registration per child would be collected on Thu, July 31st
Child's First Name
*
Child's Name
Last Name
*
Date of Birth
*
Enter child's date of birth
T-Shirt size
*
X-Small
Small
Medium
Large
Please enter child's T-shirt size
Parent First Name
*
Provide parent/guardian information
First Name
*
Last Name
*
Grade Completed
*
None
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Phone Number (preferably cell)
*
Phone Number
Address
*
Address 2
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
*
Email Address
*
(Enter your communication email address)
Days you can attend
*
Thu
Fri
Sat
Sun
T-Shirt size
Small
Medium
Large
XL
XXL
Special Needs / Allergies (if any)
Please describe any special needs or allergies that the organizers need to be aware of
Which areas would you like to help (select one or more) and enter details in the comments section (if needed)
*
Teaching (Nursery, Pre-school, Elementary 1, Elementary 2, Pre-Teen, Teen)
Games (Indoor & Outdoor)
Initial setup and decorations
Snacks & Lunch Setup
End of Day and Final cleanup
Music, Songs & Instruments
Audio, Video and Technical assistance
Please add one or more options
Provide more details on how you would prefer to help or any additional comments (optional)