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5 Day Club Registration
First and Last Name *
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Child's Gender *
Date of birth *
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DD
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Child's age
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Name of Parent(s)/Guardian(s) *
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Mailing Address *
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City *
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State *
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Zip Code *
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Contact Phone Number *
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Contact E-mail *
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Home Church *
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Emergency Contact *
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Relationship to child *
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Allergies or other medical condition(s) *
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Phone *
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