Do not press the ENTER key until you have entered all the information in the fields below.

VBS Coordinator Mr. Zach Darrow
Cell: 215-767-5735

Note: Select the most appropriate class for your child below. Depending on class sizes, however, younger students who completed kindergarten may be placed in the pre-K/Kindergarten class while older ones may be placed in the Primary 1 class.

Child's Full Name:

Birth Date:


Mother's Name:

Mother's Phone:

Father's Name:

Father's Phone:

Home Address:

Email Address:

Emergency Contact Name (other than parent/guardian):

Emergency Contact Phone (parents will be called first):

Food Allergies/Medical Concerns (provide details)?

Enter VBS to ensure proper registration: