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STAR Arts Emergency Form
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* Indicates required question
What is your child's full name?
*
Your answer
Pronouns
Your answer
Emergency Contacts
Please provide 2 emergency contacts.
Please format in this way: NAME - RELATIONSHIP TO CHILD - PHONE NUMBER
Emergency Contact #1:
*
Your answer
Contact #1 Phone Number
*
Your answer
Emergency Contact #2
Your answer
Contact #2 Phone Number
*
Your answer
Who is your child's doctor and/or medical provider?
*
Your answer
What is your child's doctor and/or medical provider's phone number?
*
Your answer
Home Address
*
Your answer
Does your child have any allergies, medications, or medical concerns we should be aware of?
*
Your answer
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