Pre-Register Kids — VBCC

Kids Pre-Registration

Name of Child

First Name

Last Name

Child's Birthday

MM

DD

YYYY

Child's School Grade

Name of Child #2

First Name

Last Name

Child #2 Birthday

MM

DD

YYYY

Child #2 School Grade

Name of Child #3

First Name

Last Name

Child #3 Birthday

MM

DD

YYYY

Child #3 School Grade

Name of Child #4

First Name

Last Name

Child #4 Birthday

MM

DD

YYYY

Child #4 School Grade

Mom's Name

First Name

Last Name

Dad's Name

First Name

Last Name

Mom's Email Address

Dad's Email Address

Mom's Phone Number

(###)

###

####

Dad's Phone Number

(###)

###

####

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Any other information that would help us care for your child: