Please remember to add an accurate phone number to parent contact information. If not provided or not correct, you may not be able to check your child in on Sunday mornings.

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* 1. We are:

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* 2. Please provide contact information for mother

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* 3. Please provide contact information for father

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* 4. Photo/video release: If you do not want photos obtained during church activity to be featured in future church publications, please request a Photo/Media Opt Out Form and submit with a current photo of your child.

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* 5. Child #1

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* 6. Child #2

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* 7. Child #3

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* 8. Child #4

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* 9. Child #5

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* 10. Child(ren) Live With:

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