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Child's Name

Child's Gender

Child's age

Date of birth

Last school grade completed

Name of parent(s)

Street address

City

State

ZIP

Home telephone

Parent/caregiver’s cellphone

Home email address

Home church

Allergies, medical conditions, or special needs

In case of emergency, contact

Phone

Relationship to child

Crew number or name (for church use only)

Are you coming for dinner?

If yes, how many would be eating dinner?

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