Registration
Last Name: * 
First Name: * 
Date of Birth (mm/dd/yy):
Address: * 
City/State: * 
Main Phone #: *  
2nd Contact #: 
Email: 
Home Church:
Spouse:
First Name:
Date of Birth (mm/dd/yy):
Contact #:
Email:
Anniversary:
Child 1:
Last Name:
First Name:
Date of Birth (mm/dd/yy):
Age: 
Grade (Fall 2016):
Gender:
Child 2:
Last Name:
First Name:
Date of Birth (mm/dd/yy):
Age:
Grade (Fall 2016):
Gender:
Child 3:
Last Name:
First Name:
Date of Birth (mm/dd/yy):
Age:
Grade (Fall 2016):
Gender:
Child 4:
Last Name:
First Name:
Date of Birth (mm/dd/yy):
Age:
Grade (Fall 2016):
Gender:
Child 5:
Last Name:
First Name:
Date of Birth (mm/dd/yy):
Age:
Grade (Fall 2016):
Gender:
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If at anytime you have a change in your contact information, please feel free to resubmit this form at your convenience.

We hope you have a wonderful day!
WCB Staff
South Dakota Website Design and Development