Child Information

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* 1. Student Information 

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* 2. Gender

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* 3. Birthdate MM/DD/YYYY

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* 4. Name of School Student Attends

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* 5. What grade is your student in?

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* 6. Do any of these apply to your child?

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* 7. Name and purpose of any medications

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* 8. Child's health history

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* 9. Dietary restrictions

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* 10. Activity restrictions

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* 11. Please list anything that may affect your child's experience at The Kroc (ie divorce, moving, health, or any special accommodations, etc.)

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* 12. Has your child previously participated in Operation Clothe a Child?

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