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Happy Walnuts After School Registration
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Basic Info
Personal Information
First Name
*
Last Name
*
Email
*
Telephone
*
Child 1 (full name)
*
Jimmy Smith
Birthdate
*
ex. 07/01/2014
Gender
*
Male
Female
Grade
*
ex. K or 1
Please list allergies, medications, medical conditions, and any special needs.
Child 2 (full name)
Birthdate
Gender
Male
Female
Grade
Please list allergies, medications, medical conditions, and any special needs.
Child 3 (full name)
Birthdate
Gender
Male
Female
Grade
Please list allergies, medications, medical conditions, and any special needs.
Child 4 (full name)
Birthdate
Gender
Male
Female
Grade
Please list allergies, medications, medical conditions, and any special needs.
Child 5 (full name)
Birthdate
Gender
Male
Female
Grade
Please list allergies, medications, medical conditions, and any special needs.
Child 6 (full name)
Birthdate
Gender
Male
Female
Grade
Please list allergies, medications, medical conditions, and any special needs.
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$50
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