G1 to G6 - New Year Eve Celebration
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Child Info
Child Name
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First Name
Last Name
Grade
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Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Child Date of Birth
*
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Month
-
Day
Year
Date
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Guardian Info
Guardian 1 Name
*
First Name
Last Name
Guardian 1 Email
*
example@example.com
Guardian 1 Cell Phone
*
Please enter a valid phone number.
Guardian 2 Name
First Name
Last Name
Guardian 2 Email
example@example.com
Guardian 2 Cell Phone
Please enter a valid phone number.
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Medical Info
Family Doctor Name
*
Family Doctor Phone Number
*
Please enter a valid phone number.
Health Card
*
Allergies
*
Waiver
Signature
*
Date Signed
*
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Month
-
Day
Year
Payment
Promo Code
Promo Multiplier
Price
Trip Price
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