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* 1. Child's Name (if you have multiple children to register please complete them all in this survey):

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* 2. Child's Birthdate

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* 3. Is your child male or female?

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* 4. Is this your first year registering with FCHA?

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* 5. Home Address:

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* 6. Home Phone Number:

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* 7. Cell Phone Number:

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* 8. Email Address:

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* 9. Which program would you like to register for?

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