Miraculous Mission: Jesus Saves the World
REGISTRATION AND MEDICAL CONSENT WAIVER
STUDENT FIRST NAME *
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GRADE JUST COMPLETED *
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STUDENT LAST NAME
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GRADE JUST COMPLETED
STUDENT FIRST NAME
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STUDENT LAST NAME
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GRADE JUST COMPLETED
STUDENT FIRST NAME
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STUDENT LAST NAME
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GRADE JUST COMPLETED
PARENT/GUARDIAN NAME *
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PARENT/GUARDIAN PHONE NUMBER *
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PLEASE LIST ANY FOOD ALLERGY *
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PLEASE LIST ANY MEDICAL CONCERNS OR LIMITATIONS OR MEDICATIONS. (TYPE NONE IF NO CONCERNS OR MEDS)(PLEASE STATE WHICH CHILD THIS CONCERNS) *
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MEDICAL INSURANCE COMPANY *
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INSURANCE POLICY HOLDER NAME *
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INSURANCE POLICY NUMBER *
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