SUPER KIDS VBS Registration

Parent Name *

First Name

Last Name

Parent Phone # *

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Child #1s Information *

First Name

Last Name

Birthdate *

MM

DD

YYYY

Child #2s (if applicable)

First Name

Last Name

Birthdate

MM

DD

YYYY

Child #3s (if applicable)

First Name

Last Name

Birthdate

MM

DD

YYYY