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VBS 2019 Registration
Email address *
Child's Name *
Your answer
Gender *
Age *
Your answer
Date Of Birth *
MM
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DD
/
YYYY
Last School Grade Completed *
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Name of Parent(s) *
Your answer
Street Address *
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Phone *
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Allergies/Medical Conditions *
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Emergency Contact Name *
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Emergency Contact Phone Number *
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Emergency Contact Relation to Child *
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Is your child from the Open Door Daycare?
Dietary needs *
$20 fee will be paid by *
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