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:
Child's last name:
Child's DOB:
Child's current school grade:
School attending:
Any allergies or health conditions that would be important for us to know:
Parents'  names:
Best email address for communication:
Cell phone for emergency contact:
Additional cell/ emergency number:
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