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Child's Name *
Select the grade your child will have completed *
Pre-K (4 year olds only) Kindergarden and 1st Grade 2nd and 3rd Grade 4th and 5th Grade 6th and 7th Grade
Child's Birthday * MM / DD / YYYY
Parent(s) / Guardian(s) Name and Address *
Phone Number * ### - ### - ####
Primary Email Address *
Emergency Contact Person and Relationship to Child *
Emergency Contact Phone Number * ### - ### - ####
Child's Doctor and Phone Number *
Person(s) Who May Pick Up Child *
Do Not Fill This Out

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