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14
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1
Primary Adult
*
This field is required.
Mr.
Mrs.
Miss.
Mr.
Mr.
Mrs.
Miss.
Prefix
First Name
Last Name
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2
Email Address
*
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example@example.com
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3
Contact Number
*
This field is required.
Please enter a valid phone number.
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4
Child 1
*
This field is required.
First Name
Last Name
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5
Date of Birth
*
This field is required.
/
Date
Year
Month
Day
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6
Grade
*
This field is required.
Please Select
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
Please Select
Please Select
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
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7
Child 2 Optional
First Name
Last Name
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8
Date of Birth
/
Date
Year
Month
Day
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9
Grade
Please Select
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
Please Select
Please Select
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
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10
Child 3 Optional
First Name
Last Name
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11
Date of Birth
/
Date
Year
Month
Day
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12
Grade
Please Select
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
Please Select
Please Select
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
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13
Photos will be taken at this event. Do you consent to have your photo released?
*
This field is required.
Yes
No
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14
Signature
*
This field is required.
By participating in this event, you consent to being photographed and to the release of these photos for marketing purposes.
Clear
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15
Image Field
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