3 Year Old - Grade 5 VBC Registration
Primary Household Information
Parent/Guardian Name(s)
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Address
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City
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State
ex: MN
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Zip Code
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Primary E-mail
If multiple e-mails, separate by a semi-colon
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Primary Phone Number
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Authorized to Pick Up Child
Other than those listed above. We will not release the child to anyone not on our lists
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