Trinity Lutheran Church

Rob Grady

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Student's Name *

Grade *

Birthday *

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Student's Name (Optional)

Grade

Birthday

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Student's Name (Optional)

Grade

Birthday

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Student's Name (Optional)

Grade

Birthday

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Address *


Address

Address Line 2

City	State	Zip Code

Home Phone *

Phone Number

Cell Phone *

Phone Number

Email *

Email Address

Parent's Name *

Medical Information (Allergies, Conditions, etc)

Emergency Contact (other than parent) *

Emergency Contact's Phone *

Phone Number

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