UPUCC Children's Church Registration
Child(ren)'s Name(s)
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Age:
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Date of Birth:
MM
/
DD
/
YYYY
Parent(s) Name:
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Siblings:
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Address:
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Email(s):
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Best phone number to reach you
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Level in School (2018/19 school year)
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Traditional or Year-Round
Child's School
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Child's Teacher
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