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Registracion del Participante

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Redeemer PCA

Location

11412 Strickland Rd

Raleigh, NC 27613

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Contact Brook Hagan:

919-518-2370

office@redeemerpca.net

Primero, cuéntenos sobre usted:

Información de los Padres

Thank you for your interest in our Wait List! Please complete this form and a member of our VBS Crew will contact you if a spot opens up for your child.

Nombre

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Apellido

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Correo Electrónico

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Contact Phone

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Emergency Contact FN & LN

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Relación del Contacto de Emergencia

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Teléfono del Contacto de Emergencia

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Street Address

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Ciudad

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ZIP/Código Postal

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Afiliación de la iglesia local

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Cuéntanos sobre tu participante

Which session will they be attending?

Nombre

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Apellido

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Género

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Fecha de nacimiento

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Grado Entrando

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Alergias

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Preocupaciones Médicas

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¿Tienes amigos con los que te gustaría estar juntos? Haremos todo lo posible para juntar a los amigos seleccionados en el mismo grupo, pero no podemos prometer que todas las solicitudes serán posibles.

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Friend 1 FN & LN

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Friend 2 FN & LN

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Comentarios

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