Servants of the Immaculata 2021-22 Registration
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Email *
Last Name *
First Name *
Husband's Name
Address
Phone
Parish
Are you Virtus trained?
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Child 1: Name/Grade/Birthdate/Age/Allergies (1 answer per line)
Child 1: Classes
Child 2: Name/Grade/Birthdate/Age/Allergies (1 answer per line)
Child 2: Classes
Child 3: Name/Grade/Birthdate/Age/Allergies (1 answer per line)
Child 3: Classes
Child 4: Name/Grade/Birthdate/Age/Allergies (1 answer per line)
Child 4: Classes
Child 5: Name/Grade/Birthdate/Age/Allergies (1 answer per line)
Child 5: Classes
Child 6: Name/Grade/Birthdate/Age/Allergies (1 answer per line)
Child 6: Classes
Child 7: Name/Grade/Birthdate/Age/Allergies (1 answer per line)
Child 7: Classes
Child 8: Name/Grade/Birthdate/Age/Allergies (1 answer per line)
Child 8: Classes
Additional Comments
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