Registration: Harvest in the Highlands

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Registration: Harvest in the Highlands

Posted October 30th, 2008 by fadmin

Harvest

Child's Information
Child's name: *
Full legal name and nickname (if different)

Age Group: *
Pre K (ages 3,4)

Kindergarten (ages 5,6)

Primary (grades 1,2)

Middler (grades 3,4)

Preteen (grades 5,6)

Birth date: *

Current school grade:

Parent's Information
Parent's name: *

2nd parent's name:

Street address: *

City/state/zip code: *

Phone number: *

Name of home church:

Emergency information
Emergency contact name:

Contact phone number:

Doctor name: *

Doctor phone number: *

Medical information:
Does this child have allergies or other medical conditions? If so, please describe.

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Posted October 30th, 2008 by fadmin

Harvest

Child's Information

Child's name: *

Full legal name and nickname (if different)

Birth date: *

Current school grade:

Parent's Information

Parent's name: *

2nd parent's name:

Street address: *

City/state/zip code: *

Phone number: *

Name of home church:

Emergency information

Emergency contact name:

Contact phone number:

Doctor name: *

Doctor phone number: *

Medical information:

Does this child have allergies or other medical conditions? If so, please describe.

Comments: