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Emmaus Picnics Sign-Up Form
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Email
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Household Name
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Primary Household Contact Name
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Primary Household Contact Phone number
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Primary Household Contact Email
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Names of all adults in the household
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Names and ages of children
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Are you willing to host a porch picnic?
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Are there any days of the week when you are regularly unavailable?
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What community group(s) are the members of your household currently attending?
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Comments, questions, or concerns?
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