Yes, Kids Can!
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Child's First Name:
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Last Name:
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Hebrew Name:
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Age:
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Birthday:
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School Attending:
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Grade:
Contact Information:
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Parent's Name:
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Home Number:
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Mobile Number
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Home Address:
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Email Address:
Medical Information:
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Are there any special medical or other information, allergies, that we should be aware of?
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Person to be contacted in case of an emergency when parents cannot be reached:
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Relationship to child:
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Home Number:
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Mobile Number:
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Family Physician and contact number:
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Medicare number:
Parental Consent
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I hereby authorize Spiritgrow staff to obtain any medical care necessary for my child. I understand that in the case of an emergency of any significant illness or injury, at tempt will be made to contact myself when practical. I agree to pay for any cost that may occur as a result of the injury/illness.
I agree
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I hereby permit my child to participate in all school activities. By signing this registration form, you are granting us permission to use photos of your child(ren) at Spiritgrow’s discretion
I agree
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Name of Parent:
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Date:
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Indicates Response Required