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Child's Name *
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Age, Weight & Shirt Size *
Example: 12, 98 lbs, Medium
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Date of Birth *
MM
/
DD
/
YYYY
School *
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Phone *
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Address *
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Family Doctor
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Allergies & Medical Conditions
Type None or N/A if not applicable
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Parent / Guardian Full Name *
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Parent / Guardian Phone *
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Best Time To Contact *
Required
Parent / Guardian E-mail *
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Emergency Contact *
Example: John Doe 555-555-5555
Your answer
Notes *
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