VBS Registration
  1. Parent Information

  2. First Name(*)
    Please type your full name.
  3. Last Name(*)
    Please type your full name.
  4. E-mail(*)
    Invalid email address.
  5. Phone
    Invalid Input
  6. Address
    Invalid Input
  7. City
    Invalid Input
  8. State
    Invalid Input
  9. Zip
    Invalid Input
  10. Miscellaneous

  11. Photo Permission(*)
    Invalid Input
    I give permission for my child/ren to be photographed and his/her image to be used in publicity for Souderton Brethren in Christ Church.
  12. Emergency Contact(*)
    Invalid Input
  13. Emergency Contact Phone(*)
    Invalid Input
  14. Alternate Pickup
    Invalid Input
  15. Alternate Pickup Phone
    Invalid Input
  16. Comments
    Invalid Input
  17. Child 1

  18. First Name(*)
    Invalid Input
  19. Last Name(*)
    Invalid Input
  20. DOB(*)
    Invalid Input
  21. Grade Entering(*)
    Invalid Input
  22. Medical / Allergies(*)
    Invalid Input
  23. Child 2 (Optional)

  24. First Name
    Invalid Input
  25. Last Name
    Invalid Input
  26. DOB(*)
    Invalid Input
  27. Grade Entering(*)
    Invalid Input
  28. Medical / Allergies(*)
    Invalid Input
  29. Child 3 (optional)

  30. First Name
    Invalid Input
  31. Last Name
    Invalid Input
  32. DOB(*)
    Invalid Input
  33. Grade Entering(*)
    Invalid Input
  34. Medical / Allergies(*)
    Invalid Input
  35. Child 4 (optional)

  36. First Name
    Invalid Input
  37. Last Name
    Invalid Input
  38. DOB(*)
    Invalid Input
  39. Grade Entering(*)
    Invalid Input
  40. Medical / Allergies(*)
    Invalid Input

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