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First Baptist Church Crystal Beach
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Students Name (
Required
)
Parent/ Guardian Name (
Required
)
Parent/ Guardian Email
Parent/ Guardian Phone Number (
Required
)
Physical Address (
Required
)
|
Mailing Address/ PO Box
Gender
Male
Female
Birthday
Please add your students birthdate
January
February
March
April
May
June
July
August
September
October
November
December
Age Group (
Required
)
Preschool
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Medical Information
Please list any medical issues, conditions, or allergies your student may have.
Secondary Emergency Contact
Please list a secondary emergency contact (name, number, and relation to student)
Pick up persons
Please list the names of anyone who is authorized to pick up your student.
Any other information we may need to know?
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