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Never Fear Being Different
Name
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First Name
Last Name
School
*
Grade
*
1st
2nd
3rd
4th
5th
6th
What is child's Passion? ex. Art, Sports, etc.
*
Address
*
Phone
*
(###)
###
####
Emergency Contact Name, Number and Relation to Child
*
Please List any allergies the child has
*
Email
Child #2 Name
Child #2 Grade
1st
2nd
3rd
4th
5th
6th
Child #2 Allergies
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