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Co-Curricular Registration 2025 - ceramics club
ceramics club- zefran
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Student's First Name *
Student's Last Name *
Student's Student ID Number *
Student's Date of Birth *
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Student's Address *
Grade for 2025-2026 School Year *
First Parent/Guardian First and Last Name *
First Parent/Guardian Phone Number and Email Address *
Second Parent/Guardian First and Last Name *
Second Parent/Guardian Phone Number and email address *
Other Emergency Contact First and Last Name *
Other Emergency Contact Phone Number *
Please provide the following insurance information:
          - Insurance provider
          - Insurance Policyholder
          - Member ID
          - Group # if there is one
 *
Any allergies or other concerns the advisor should know about? *
In the event of an emergency, anything else administration, or EMS should know *
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