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Application for Admission to Omaha Memorial Adventist School
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Child's Full Legal Name
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Home Address
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City
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State
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Zip
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Phone
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Age
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Sex
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Race
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Date of Birth
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Church attending
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In case of emergency who should we notify? Please include their phone number.
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Family physician: (Please include their phone number)
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Family Dentist: (Please include their phone number)
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