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Father's Self-Care Day Registration Form
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Email
*
Your email
Name (First and Last)
*
Your answer
Zip Code
*
Your answer
Phone No.
*
Your answer
Child Diagnosis (i.e. ADHD, Autism, etc.)
Please list ALL diagnoses!
*
Your answer
Please choose what you would like for lunch!
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Hanger Steak
King Salmon en Papillote
KASEC will be taking photos and videos throughout the event to use for parent educational and organizational promotion purposes.
Please sign your name below to acknowledge that you understand our photo/video taking policy.
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Your answer
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