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Email
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Your email
Name of Mother & Father
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Your answer
Mailing Address (P.O. Box/House Number, Steet, City, & Zip)
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Your answer
Primary Contact Number During PSR Hours (Name & Phone #):
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Your answer
Primary Contact Number Outside of PSR Hours (Name & Phone #):
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Your answer
Can we text you?
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Additional Contact Number:
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My child/children primarily attend:
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Ss. Mary & Joseph - Carlinville
Ss. Simon & Jude/ St. Joseph - Gillespie
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