Student Information

Student First Name

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* 1. Student First Name

Student Last Name

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* 2. Student Last Name

Student Age

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* 3. Student Age

Student Date of Birth (MM/DD/YYYY format)

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* 4. Student Date of Birth (MM/DD/YYYY format)

Date of Birth
Student Grade

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* 5. Student Grade

Please place my child with: (We will make every effort to honor requests, as long as the group is age appropriate. Please note: we can only move a child DOWN to a lower age group. We cannot move a child up in age to be with an older friend.)

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* 6. Please place my child with: (We will make every effort to honor requests, as long as the group is age appropriate. Please note: we can only move a child DOWN to a lower age group. We cannot move a child up in age to be with an older friend.)

Home Church

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* 7. Home Church

Food Allergies (leave blank if none)

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* 8. Food Allergies (leave blank if none)

Other Allergies/Medical Conditions/Special Instructions or Needs (leave blank if none)

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* 9. Other Allergies/Medical Conditions/Special Instructions or Needs (leave blank if none)

Doctor's Information (Optional)

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* 10. Doctor's Information (Optional)

Student will be walking from the neighborhood to Adventure Week

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* 11. Student will be walking from the neighborhood to Adventure Week

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20% of survey complete.

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