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Registration for VBS

Please complete and submit the form below. Or download HERE and email to ccrayment@gmail.com.

Last Name
First Name
First Name
Please list full name, DOB, Grade Level
Street Address *
Street Address
Mailing Address
Mailing Address
Please fill out if different from street address.
Contact Number: *
Contact Number:
Emergency Contact *
Emergency Contact
Emergency Contact Phone # *
Emergency Contact Phone #