2017 BLF Summer Registration
Child's Last Name
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Child's First Name
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Birthdate
Farm Program participants must be 5 to participate. 5 and 6 year olds are limited to half day Farm sessions. The Horse Program is for students 8 years and older.
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DD
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Grade in the Fall
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Gender
Parent/Guardian 1 Name
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Phone Numbers for Parent/Guardian 1
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Email Parent 1
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Street Address or PO Box
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City
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State and Zipcode
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Parent/Guardian 2 Name
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Phone Numbers Parent 2
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Email Parent 2
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Other Full Address
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Emergency Contact Name(s)
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Emergency Contact Phone numbers
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Authorized Pick Up - Please list name and phone number.
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