Registration | lifepointprosser

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KID'S VBS REGISTRATION BASIC INFO FORM

CHILDREN'S NAMES, BIRTHDAYS, AND AGES

NAMES OF FAMILY OR FRIENDS ALLOWED TO PICK UP YOUR CHILD.

EMERGENCY CONTACT NAME AND NUMBER

DO ANY OF THE ABOVE HAVE FOOD OR MEDICATION ALLERGIES

YES

NO

DO ANY OF THE ABOVE HAVE SERIOUS MEDICAL CONDITIONS WE NEED TO BE AWARE OF?

YES

NO

IF YOU ANSWERED YES TO EITHER OF THE ABOVE QUESTIONS PLEASE LIST NAMES, ALLERGIES, AND MEDICAL CONDITIONS

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