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GOYA Registration Form 2018-2019
Cathedral of St. John the Theologian, Tenafly NJ
Email address *
GOYA member name: Last, First *
Your answer
Address *
Your answer
GOYA member Cell Phone number *
Your answer
Birthdate *
Your answer
Grade & School *
Your answer
Father's name, phone, email *
Your answer
Mother's name, phone, email *
Your answer
**MEDICAL EMERGENCY INFO* Doctor's name & phone# *
Your answer
**MEDICAL EMERGENCY INFO* Hospital choice *
Your answer
**MEDICAL EMERGENCY INFO* Medical Problems, Medications, Allergies *
Your answer
**MEDICAL EMERGENCY INFO* Emergency Contact name & phone#: *
Your answer
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