VBS Registration

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Online Registration

Child's First Name

Child's Last Name

Parent/Guardian

Address

Phone

Email

Birth Date

Last grade completed

Medical information/allegies?

EMERGENCY CONTACT

I authorize use of VBS photos that include my child for promotion only.

Thanks for registering your child!

6361 Pony Express Trail

PO Box 59

Pollock Pines, CA 95726

530-644-2133

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