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VBS Registration
If you are human, leave this field blank.
Child's First Name
*
Child's Last Name
*
Parent/Guardian First Name
*
Parent/Guardian Last Name
*
Email Address
*
Street Address
*
City
*
State
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
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NJ
NM
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NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip
*
Phone Number
*
Child's Grade Completed
*
Will attend Pre-Kindergarten/Pre-School in the fall
Pre-Kindergarten/Pre-School
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
All children must be potty-trained.
Child Food Allergies
*
Yes
No
What kind of allergies does your child have?
Any special concerns or limitations?
*
Yes
No
What are the special concerns or limitations for your child?
Emergency Contact
*
Emergency Phone Number
*
Payment
You will automatically be directed to the payment page when you hit "SUBMIT". If you do not want to pay online, then just close the payment page browser after you hit the "SUBMIT" button on this registration. You will get an email confirming your child's registration, even if you do not pay online.