Central Reformed Church STARS
Student's Education & Activity Registration Form
First Name of Child 1
Your answer
Last Name of Child 1
Your answer
Birth Date (mm/dd/yyyy)
Your answer
School Grade (Current)
Child 1 will participate in:
Please list the child Insurance Policy Number. (if it is the same as your Family Insurance Number please leave blank)
Your answer
Does this child have specific needs and/or allergies, that may need special attention, if needed?
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