174 Holmes Street, Belleville, NJ
VBS Registration Elementary

Please fill in all the blanks. Before Submitting enter the security numbers as displayed. **Make sure you use a space between the numbers. Thank you.

Parent/Guardian Name

Child's Name

Address

City

Zip

Age

Gender

Contact Email

Phone #

Enter the numbers from the image:



          
174 Holmes Street, New Jersey, 07109, United States
973-759-0726
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