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Pre-Register Each Child Here
We can't wait to see you at Breaker Rock Beach!
2024 VBS REGISTRATION
Last name
First name
Birthday
Last Grade Completed in School
Choose an option
Does your child have any food allergies?
*
No
Yes
Please list any food allergies:
Other Medical Conditions that we need to know:
Parent/Guardian Name
Parent/Guardian Name
Street Address
City
State
Postal / Zip code
Mailing Address (if different)
City
State
Postal / Zip code
Phone
Phone
Email Address
Email Address
Other Emergency Contact
Phone
Other Emergency Contact
Phone
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