VBS 2026 Registration Form

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VBS Registration Form

Child’s Name (First & Last)

Child’s Age

Child's Grade (Fall 2026)

Child's School

Other

Parent Name(s)

Parent’s Cell # in case of emergencies

Best email address to reach you

Medical, Allergies or Special Needs

2902 Montrose Ave. La Crescenta, CA 91214 | lcpc.net | Tel: 818-249-6137

Office Hours: Mon - Fri: 9am-5pm | Services: Sundays at 10am, In-Person & Online

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