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Torah Center Registration Form 2021-22
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* Indicates required question
Parent/Guardian #1 Name
*
Your answer
email
*
Your answer
Cell Phone
*
Your answer
May we send you text message?
Yes
No
Clear selection
Home Phone
Your answer
Parent/Guardian #2 Name
Your answer
email
Your answer
Cell Phone
Your answer
May we send you text message?
Yes
No
Clear selection
Home Phone (ONLY if different from above)
Your answer
With whom does the child reside?
*
Both Parents
Parent/Guardian #1
Parent/Guardian #2
Emergency Contact Name
*
Your answer
Cell
*
Your answer
Home Phone
Your answer
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