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2023 VBS REGISTRATION
STUDENT'S NAME
GENDER
MALE
FEMALE
DATE OF BIRTH
AGE
PARENT/GUARDIAN NAME
RELATIONSHIP
ADDRESS [INCLUDE CITY, STATE, ZIP]
PHONE NUMBER
EMAIL
ALLERGIES/MEDICAL CONDITIONS
EMERGENCY CONTACT
RELATIONSHIP
HOME PHONE NUMBER
CELL PHONE NUMBER
OTHER PEOPLE AUTHORIZED TO PICK UP CHILD
SUBMIT
THANKS FOR REGISTERING
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