BELIEVE CENTER INC. WAIVER FORMS
Participant First Name *
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Last Name *
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Date of Birth *
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Address
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City *
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State *
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Zip Code *
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Phone Number *
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Low-Mod Number
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Grade
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School
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Race
Email or type none *
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Emergency Contact Name *
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Emergency Contact Phone Number *
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Does your child have any current condition that limits his/her ability to participate in this activity?
Please provide information about condition, allergies or medical conditions that Believe Center Inc.should have in case of emergency or type none.
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