Childs Name *

First Name

Last Name

Childs Gender *

Male

Female

Name of Parent *

First Name

Last Name

Home Telephone *

(###)

###

####

Parent/Caregiver's Cellphone Number *

(###)

###

####

VBS SCUBA T-SHIRT

Check one box: YES for purchasing or NO for not purchasing

Yes, I would love to purchase a VBS Scuba T-Shirt

NO, I will not purchase a T-shirt, maybe next year.

Youth T-Shirt Size

YXS

YS

YM

YL

YXL

Adult Scuba T-Shirt

Small

Medium

Large

Extra Large

2X

3x

4x add $2.00 total of $14.00