Cross Walk 19-20
Child's First Name *
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Child's Last Name *
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Birthdate *
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DD
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Grade for Fall of 2019 *
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Allergies/Special Needs *
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Parent/Guardian *
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Street Address *
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City *
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State *
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Zip Code *
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Home Phone *
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Work Phone
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Cell Phone *
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E-Mail
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Home Church *
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Emergency Contact *
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Emergency Contact Phone Number *
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Permission to take Pictures for Publicity Purposes *
I would like to volunteer during Cross Walk *
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