VBS Summer Camp Registration

VBS SUMMER CAMP IS BACK!
When: August 15th-19th
Time: 10am - 2pm
Where: Michael E. Reilly Fireman's Park I DeWitt Ave, Patchogue
Who: All kids ages 4-12yrs old
Cost: FREE!!

* Indicates required field

Camper's Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

How old is your camper? *

Emergency Contact *

First

Last

Emergency Contact Phone Number *

Emergency Contact Email *

Emergency Contact's Relationship to Camper *

If your child has allergies, please list them below. If not, please write N/A. *

Would you like to be notified of other Kid's Events we have throughout the year? *

Yes No

For promotional purposes, pictures and/or videos of children may be taken. Please check the box below if you will or will not give consent. *

Yes No

Please have your camper bring the following items:

A bagged lunch
Extra bottle of water

Submit