Lowville Summer Rec 2016
Child's Name *
Your answer
Age *
Your answer
Grade Completed *
Minimum completed kindergarten - Maximum completed 5th Grade
Street Address *
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City *
Your answer
State *
Your answer
Zip *
Your answer
Cell Phone Number *
Your answer
Emergency Contact Name #1 *
Your answer
Emergency Contact Phone Number #1 *
Your answer
Emergency Contact Name #2 *
Your answer
Emergency Contact Phone Number #2 *
Your answer
Medical Alert (If applicable)
Your answer
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