Friday Night Clubs
Pioneer Girls & Boys Brigade, meets Friday Nights at the Randolph Campus.
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Parent/Guardian Full Name *
First & Last Name
Relationship to Child *
Phone Number: *
Parent/Guardian Full Name
First & Last Name
Relationship to Child
Phone Number: *
Home Address *
Street, City, State, Zip Code
Home Church
Email *
I would be willing to help with the club ministry as needed *
Emergency Contact (Full Name) *
OTHER THAN PARENT/GUARDIAN
Emergency Contact Relationship to Child *
Emergency Contact's Phone Number *
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