2018-2019 Code 9 Registration
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Today's Date *
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Parent #1 Name *
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Cell Nbr *
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Parent #2 Name
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Cell Nbr
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Home Address (Street Address, City, State, Zip) *
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Email *
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Do you and your child/children attend Church? *
If Yes, Where do you attend?
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Child 1 Name *
Your answer
Child 1 lives with *
Required
Child 1 Gender *
Child 1 DOB *
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Child 1 Current Grade *
Child 1 Allergies or Medical Conditions *
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Child 2 Name
Your answer
Child 2 lives with
Child 2 Gender
Child 2 DOB
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DD
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YYYY
Child 2 Current Grade
Child 2 Allergies or Medical Conditions
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Child 3 Name
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Child 3 lives with
Child 3 Gender
Child 3 DOB
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DD
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YYYY
Child 3 Current Grade
Child 3 Allergies or Medical Conditions
Your answer
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