Synergy Winter Jam 2019
Email address *
Participant's Name *
(First & Last Name)
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Current Grade Level *
Emergency Contact Person *
(First & Last Name)
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Emergency Contact Phone Number *
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Emergency Contact Relation to Participant *
(Father, Mother, Grandparent, Guardian, etc.)
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Please contact Pastor Daryl at daryl@mgbconline.com if you have any questions!
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