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2018 HSM Mission Trip Registration
Student's Last Name *
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Student's First Name *
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Grade in Level in Fall 2018 *
$50 Deposit Made *
LC3 Parent Permission Form Turned In *
YouthWorks Participant Release Form Turned In (3 Pages) *
Parent E-mail Address *
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Parent/Guardian Name & Phone Number *
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Emergency Contact Name & Phone Number *
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Medications/Allergies/Medical/Etc *
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Notes or Questions
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