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Registration Form.
Event Timing: Friday, 6 p.m.-10 p.m.
Event Address: 1911 N Pine Island Rd, Plantation, FL 33322
Contact us at 1 754 801 2288 or
e-mail
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Child’s First and Last Name
*
Your answer
Date of Birth mm/dd/yyyy
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MM
/
DD
/
YYYY
Home Address, including ZIP code
*
Your answer
Parent's/Guardian's First and Last Name
Your answer
Cell Phone
*
Your answer
Email
Your answer
Emergency Contact Details
Your answer
Child’s Allergies/Medical Conditions/Other
Your answer
On what date would you like to book a spot in the program?
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DD
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YYYY
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