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Name
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First
Last
Child's Grade
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Current 4th Grader
Current 5th Grader
Parent/Guardian Name
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Cell Phone Number
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Address
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City
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State
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Zip Code
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Parent/Guardian Email
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Child's Food Allergies
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Emergency Contact Name
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Emergency Contact Phone #
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Emergency Contact Relationship to Child
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Other Allergies or Medical Conditions
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May we have permission to photograph and/or video your child for use in church publications?
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Yes, you have permission to photograph/video my child.
No, I do not give permission to photograph/video my child.
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