VBS Online Form | saintmildred

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Catholic Church

All fields are required. Click on the Submit button when completed. Your child will then be registered.

Child's Name

Date of Birth

Street Address

City

State

Zip Code

Home Phone

Parent/Caregiver Mobile Phone

Home Email Address

Home Parish

Allergies, Medical, Special Needs

Emergency Contact

Emergency Contact Phone

Relationship to Child

Your registration has been submitted

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