AWOMMA 2017 Registration Form
AWOMMA (A Week of Making Music and Art) will be held at FUMC Stephenville from Sunday, July 30-Wednesday, August 2.
Email address
Child's Name
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Date of Birth
MM
/
DD
/
YYYY
Last grade completed
Home phone (or cell)
Your answer
Address
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City
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State
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ZIP code
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Mother's Name
Your answer
Mother's Phone
Your answer
Father's Name
Your answer
Father's Phone
Your answer
Other Emergency Contact
Your answer
Other Emergency Contact Phone
Your answer
Name of other person who will pick up this child
Your answer
Phone Number of pickup person
Your answer
Allergies/Special Needs (food, medicine, etc.)
Your answer
Preferred Physician
Your answer
Preferred Physician Phone
Your answer
Confirmation
Required
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