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VBS Registration Form-2019
ONE PER CHILD
Child's Name *
Your answer
Child's Age *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Child's Gender *
Last School Grade Completed *
Your answer
Name of Parent(s)/Guardian(s) *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Main Telephone Number *
Your answer
Email address *
Your answer
Home Church *
Your answer
Allergies *
Allergies:
Your answer
In case of Emergency, contact: *
Your answer
Relationship to Child: *
Your answer
Emergency Contact Number: *
Your answer
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