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YIPC Youth Group Registration 2018
Please complete this form in full. For multiple children, please complete a separate form for each child.
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Child's first name:
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Child's last name:
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Child's DOB:
MM
/
DD
/
YYYY
Child's current school grade:
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School attending:
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Any allergies or health conditions that would be important for us to know:
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Parents' names:
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Best email address for communication:
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Cell phone for emergency contact:
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Additional cell/ emergency number:
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