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* 1. Please list your student(s) name and age:

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* 2. Parent/Adult Name:

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* 3. Phone Number:

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* 4. My student(s) will be to attend the following dates: (check all that apply)

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* 5. Will your student(s) need to ride the bus to or from service?

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* 6. If yes, please provide address:

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* 7. Check the box below, to consent to all activities at Faith Tabernacle this summer, including the bus route as needed.

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