Time for Two Application 
Please complete this form to register your child for St. Luke's Time for Two Program 
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Class Dates
Time: 9:30 - 11:00 
September 9th, 16th, 23rd, 30th
October 7th, 21st, 28th
November 4th, 11th 
Payment
The cost for the class is $75 and is due by the first class date
Student Full Name *
Date of Birth *
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Medical Conditions or Allergies (If none, please enter N/A) *
Parent or Guardian Name *
Email Address *
Phone Number  *
Name of Adult Attending Class *
Adult Relationship to Student *
Names and Birthdays of Siblings 
Current Church Attended 
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Describe your child's interests and strengths *
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