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Event Registration

Child First Name:
Child Last Name:
Birth Month:	Select 01 02 03 04 05 06 07 08 09 10 11 12
Birth Day:	Select 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Birth Year:
Grade Completed:	Select Not in School Pre-K K 1 2 3 4 5 6 7 8 9 10 11 12
Age:	Select 01 02 03 04 05 06 07 08 09 10 11 12
Parent First Name:
Parent Last Name:
Address:
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Home Phone:
Cell Phone:
Email:
List All People Who Are Allowed to Pick Up Your Child:
Emergency Contact:
Emergency Phone:
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Home Church (if any):
I authorize my child's photo to be taken and used for our website use.	SelectYESNO
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