Child's Name(s) (Please list all children in family):

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* 1. Child's Name(s) (Please list all children in family):

Child's Gender (s) (Please list all children in family):

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* 2. Child's Gender (s) (Please list all children in family):

Child's Age (s) (Please list all children in family):

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* 3. Child's Age (s) (Please list all children in family):

Date(s) of Birth:

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* 4. Date(s) of Birth:

Last school grade(s) completed:

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* 5. Last school grade(s) completed:

Name of Parent(s):

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* 6. Name of Parent(s):

Contact Info:

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* 7. Contact Info:

Home Church:

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* 8. Home Church:

Allergies or other medical conditions:

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* 9. Allergies or other medical conditions:

In Case of Emergency

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* 10. In Case of Emergency

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