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3:16 Registration Form

Please print this form using your browser's print button. Completed forms may be left at the church office.

Child's Name: _________________________________________________________________ Age: ____________________

Street Address: ________________________________________________________________________________________

City: _______________________________________________________ State: __________ ZIP Code: _________________

Home Telephone: (____) ________________________________________________________________________________

Parent/Caregiver's Cell Phone: (____) ______________________________________________________________________

Home E-mail Address: ___________________________________________________________________________________

Date of Birth: _________________________ School Grade: ____________ Campus: _______________________________

In case of emergency, contact: ___________________________________________________________________________

_____________________________________________________________________________________________________

Mother: ______________________________________________________________________________________________

Father: _______________________________________________________________________________________________

People allowed to pick up your child: ______________________________________________________________________

_____________________________________________________________________________________________________

Allergies or other medical conditions: _______________________________________________________________________

Home Church: _________________________________________________________________________________________

 

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202 North Oklahoma Street ~ Fort Stockton, Texas 79735 ~ Phone: (432) 336-3346 ~ Fax: (432) 336-6717
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