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Homeschool Program Registration
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1
Parent Name
First Name
Last Name
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2
Email
example@example.com
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3
Phone Number
Please enter a valid phone number.
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4
Select Library Branch
Aurora,
Cassville,
Eagle Rock,
Marionville,
Miller,
Monett,
Mt. Vernon,
Pierce City,
Shell Knob
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5
Child's Name
First Name
Last Name
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6
Child's Birthdate
-
Date
Year
Month
Day
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7
Allergies or medical condition?
My child has food allergies or medical condition that staff should be aware of.
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