VBS Registration

475 Colliers Way
Weirton, WV 26062
304 - 723 - 2006

VBS Registration Form

* Indicates required field

Childs Name *

First

Last

Childs Name *

First

Last

Childs Age Group *

Parent/Guardian Name *

First

Last

Parent/Guardian Phone Number *

Food Allergies *

Yes No

If selected yes please specify what allergies your child has *

Submit