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How many children would you like to register today?
1
2
3
4
Child 1
Participant’s Name
Sex
Male
Female
Date of Birth
Grade entering this upcoming September
Preschool
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eight Grade
School Attending
Child 2
Participant’s Name
Sex
Male
Female
Date of Birth
Grade entering this upcoming September
Preschool
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eight Grade
School Attending
Child 3
Participant’s Name
Sex
Male
Female
Date of Birth
Grade entering this upcoming September
Preschool
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eight Grade
School Attending
Child 4
Participant’s Name
Sex
Male
Female
Date of Birth
Grade entering this upcoming September
Preschool
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eight Grade
School Attending
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Parent
Parent / Guardian
Address
E-mail
Cell Phone
Home Phone
Emergency Contact Information
Any children have Allergies or Special Needs?
Person responsible for picking up child at the end of each VBS day:
Name
Phone
Total Amount
Verification
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