Senior High Kick Off Registration
Student First Name
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Student Last Name
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Student Cell Phone
Your answer
Student Grade in the Fall
Parent Name
Your answer
Parent Cell Phone
Your answer
Parent Email
Your answer
Home Address
Your answer
Zip Code
Your answer
Insurance Provider
Your answer
Policy Holder
Your answer
Policy Number
Your answer
Any Allergies or Conditions
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Liability Information
The Staff and Chaperones of First Presbyterian Church Glen Ellyn have my permission to seek medical care for my child(ren) in the case of an injury or accident. We will make every effort to contact you, but in the event I cannot be reached, the medical professionals have my permission to treat my child(ren) as deemed necessary.
I have read and agree to the above stated conditions for my students participation.
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