Gems of the Heart- Group Registration

General information

Please complete the information for those participating. Please list multiple children registering from oldest to youngest (i.e. Child 1 = oldest, Child 15 = youngest)

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* 1. Today's Date

Date

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* 2. Organization (ex. School name, Girl Scouts etc.):

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* 3. Person completing this form:

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* 4. Number of children participating (max. 15):

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* 5. Names and ages of children participating (max. 15):

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

Child 7

Child 8

Child 9

Child 10

Child 11

Child 12

Child 13

Child 14

Child 15

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* 6. Organization address:

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 7. Primary contact person for organization:

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 8. Is it okay to leave messages at listed phone and email? Please specify:

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* 9. Secondary contact person for organization:

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 1. Today's Date

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* 2. Organization (ex. School name, Girl Scouts etc.):

Question Title

* 3. Person completing this form:

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* 4. Number of children participating (max. 15):

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* 5. Names and ages of children participating (max. 15):

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* 6. Organization address:

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* 7. Primary contact person for organization:

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* 8. Is it okay to leave messages at listed phone and email? Please specify:

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* 9. Secondary contact person for organization:

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* 10. Is it okay to leave messages at listed phone and email? Please specify: