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2005 VBS REGISTRATION / REQUEST FOR MORE INFORMATION

(Please ensure that you provide at least one telephone number in order for us to call you back to confirm your registration.)

Name of parent or guardian:
Email address:
Name and age of each child: (eg. "Sally (5)")
Check if special health/diet concerns:
Mailing address: (Include postal code)
Daytime phone number:
Evening / alternate phone number:
Best time to call:
Comments/Questions:

Last updated: June 12th, 2005
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