VBS Registration — JCC

Child's Name

First Name

Last Name

Grade Just Completed (Preschoolers must be at least 4 yrs old and fully potty trained)

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian

First Name

Last Name

Parent/Guardian Phone - this will also be the emergency contact

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Allergies/Special Instructions