WBC VBS Registration 2017
* Required
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
Child's Gender
*
Male
Female
Team
For administrative use.
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Green
Red
Yellow
Blue
Food Allgeries
List all. Leave blank in none.
Your answer
Other Allgeries
List all. Leave blank in none.
Your answer
Medical Condition
Please describe any medical conditions we should be aware of.
Your answer
Fathers's Name
First Name LastName
Your answer
Father's Phone
Your answer
Father's Email
Your answer
Mother's Name
First Name LastName
Your answer
Mother's Phone
Your answer
Mother's Email
Your answer
Additional Contact Name
Please list any additional contacts we should include incase of emergency or for pickup authorization.
Your answer
Additional Contact Phone
Your answer
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