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Cascade Community Church Permission slip
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* Indicates required question
Full Name of Kid
*
Your answer
Birthday
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Year in school
*
Choose
6th
7th
8th
Freshman
Sophomore
Junior
Senior
Mailing Address
*
Your answer
Phone #
*
Your answer
Medical Insurance Company & Policy #
*
Your answer
Mothers name & phone number
*
Your answer
Father's name & phone number
*
Your answer
Emergency contact name and number
*
Your answer
Physician name, and office number
*
Your answer
Dentist name, and office number
*
Your answer
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