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Student Name *
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Address *
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Address Continued *
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Home Phone Number *
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Anticipated Grade For Next Year *
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Church You Currently Attend
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How Often Do You Attend
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Pay By Cash
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Pay By Check
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Pay By Credit (PayPal)
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Registration fee for each child:
(non-refundable)
$ 30.00 by April 22
$ 50.00 by May 1
$ 80.00 by June 1
$150.00 after June 1
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Parent Signature *
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Date *
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