Children and Youth Registration

Child's Name

First Name

Last Name

Parent/Guardian Email #2

Grade in School 2023-2024

Allergies if any

Parent/Guardian Phone

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Child's Phone if Applicable

(###)

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

May St. Luke's and/or St. Paul's use your child's picture in social media, print media and websites?

Yes

No

Is there anything else that we need to know about your child?

By typing your name into this box you submit your digital signature

Email

Parent/Guardian Phone #2

(###)

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