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VBS Registration Form

Child's Name *
Child's Name
Parent/Guardian Name *
Parent/Guardian Name
Address *
Address
Phone *
Phone
Child Age Information
Birth Date *
Birth Date
Medical or other information we need to know. (Please include any food allergies.)
Emergency Contacts
(Other than listed above)
Emergency Contact 1 *
Emergency Contact 1
Phone 1 *
Phone 1
Emergency Contact 2
Emergency Contact 2
Phone 2
Phone 2
Dismissal Information
Other Information
May we have permission to photograph your child? *
May we have permission to use your child’s photograph for the purpose of promotion? *