Sam's Club Registration Form
Register only if your child/children are of age 5 to 10
Please provide all the details below.  The details you provide will help us to serve your child/children better.
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Name - Child 1: *
Date of Birth: *
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Name - Child 2:
Date of Birth:
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DD
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YYYY
Name - Child 3:
Date of Birth:
MM
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DD
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YYYY
Father's Name:
Mother's Name:
Address:
Contact Information (Phone): *
Email id: *
Home Church:
Any known food allergy:
Any known medical condition:
Permission to take and use pictures in Media *
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