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Happy Walnuts After School Registration
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First Name
*
Last Name
*
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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
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Child 3 (full name)
Birthdate
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Male
Female
Grade
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Child 4 (full name)
Birthdate
Gender
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Female
Grade
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Child 5 (full name)
Birthdate
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Female
Grade
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Child 6 (full name)
Birthdate
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Female
Grade
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