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Aikido for Kids Registration Form - $50 per person for 8 sessions
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* Indicates required question
First and Last Name
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Gender
*
Girl
Boy
Parent/Guardian First and Last Name
*
Your answer
Email
*
Your answer
Mobile Number
*
Your answer
Street
*
Your answer
Town
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
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