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Registration Form
Registration Form
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Indicates required field
Child's Name
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First
Last
Child's Date of Birth
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Child's Address
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Phone Number
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Parent(s) name
*
First
Last
Email
*
Session
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Morning Session 9:00-11:30 AM
Afternoon Session 12:30-3:00 PM
I understand that I must have a current medical statement signed by a physician for my child not later than 30 days after my child's admission.
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Yes
No
I understand that my child is not registered for class until I pay my $75.00 registration fee.
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Yes
No
How did you hear about us
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Submit
Make checks payable to : Central Christian Church
1504 Villa Rd.
Springfield, OH 45503