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Participant Registration

*Participant's First Name:	__________________________________
*Participant's Last Name:	__________________________________
*Parent/Guardian Name:	__________________________________
*Address:	__________________________________
*City:	__________________________________
*State:	__________________________________
*Zip:	__________________________________
*Cell Phone:	(______)______-________
*Email:	__________________________________
*Birthday:	__________________________________
*Last Grade Completed:	__________________________________
Allergies, Medical, & Special Needs:
We will be taking photographs of the children and they will be used as promotion and on social media, etc.
*Emergency Contact Name (1):	__________________________________
*Emergency Contact Phone (1):	(______)______-________
Do you attend Church?:	Yes   No  (circle one)
If so, where?:	__________________________________
*Preferred Name for Name Tag:	__________________________________

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