Grades K4-K5: PHPC VBS 2025 Upward Bound Registration - June 16-20
Mon-Fri, June 16th -20th , 9am - 12pm | Please fill out this form and click submit.
This form is for children who will complete K4 or K5 by Summer of 2025.
Child's Name
*
Child's Date of Birth
*
Address
*
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Allergies
Shirt Size
*
Please select one option.
Youth xsmall (4-5)
Youth small (6-8)
Youth medium (10-12)
Youth large (14-16)
Parent's Email
*
This address will receive a confirmation email
Parent/Guardian Full Name
*
Parent/Guardian Phone Number
*
Emergency Contact Full Name (different from Parent/Guardian)
*
Emergency Contact Phone Number (will only use if Parent/Guardian can not be reached)
*
Where did you hear about our VBS?
*
Please select one option.
School Flyer
Community Advertising/Sign
Friend or Family
You are a current member or visitor of PHPC
Submit
Description
Mon-Fri, June 16th -20th , 9am - 12pm
Please fill out this form and click submit.
×
Please Fix the Following