VBS Registration

This form uses e-mail to submit and depending on your security settings, your browser may ask for permission to do so. If you wish to use the form, you will need to select yes if/when prompted.
It also requires an installed email program such as Outlook; it will not work with web-based email.
If you can get to the form but can't send it; feel free to simply supply the requested information via email to medfordbaptist@verizon.net
Please submit one form per child you wish to register.

Child's Last Name:
Child's First Name:
Street Address:
Street Address Continued:
City:
State:
Zip:
Contact Phone#:
Parent/Guardian Name:
Email:
Child's Age:
What grade will the child be
entering in September of 2021: