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* 1. Name of Parents or Guardians who will be participating and Phone Numbers

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* 2. Please list the Name of each Child participating, their Birth Date (mm/dd/yy), and Grade (as of 9/12/2018)

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* 3. Mailing Address

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* 4. What is the best e-mail address to use to contact your family?

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* 5. If a child listed has an allergy and/or medical condition that you would like us to know about, please provide that information below.

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* 6. How did you hear about our Midweek Program?

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* 7. What Church do you attend?

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* 8. If you have any questions or concerns, please write them below and someone from Zion Lutheran will contact you to answer those questions.

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