J.A.M.ers and Kids Connection Registration Form 2021-2022
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Child's Last Name: *
Child's First Name: *
Mailing Address: *
Postal Code: *
Primary Phone Number: *
Name of Parent(s)/Guardian(s): *
Parent Email:
Date of Birth: *
MM
/
DD
/
YYYY
2021-2022 School Grade: *
Does your child have any allergies or medical conditions we should be aware of: *
If your answer is "yes" to the above question, please provide us with details:
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