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Parents:     Child:       Child DOB:  
Gender:        School Grade:       School:

Street:   City, State, Zip:  Phone:
Dad's Phone:     Employer:   Occupation:
Mom's Phone:   Employer:   Occupation:

Emergency Name:   Phone #:
Family Doctor:        Phone #:

 Class:     Register Date:       Register #:  
 Paid For?        Notes:      Email:
T-Shirt Size:        

Current Safety Village Registration *
* When 1 class is listed and payment is shown as recieved, your child is completely registered for that class. You will also receive a confirmation email when this happens.

Class History
Class IDClass AgesSessionStart DateEnd DateMax StudentsActiveNotes
0003Age 5-7Mornings06/18/201806/22/201840N2018 - AM class for 5-7 year olds
0006Age 8-10Afternoons06/18/201806/22/201840N2018 - PM class for 8-10 year olds
0001Age 5-7Mornings06/11/201806/15/201840N2018 - AM class for 5-7 year olds
0004Age 5-7Afternoons06/19/201706/23/201740N2017 - PM class for 5-7 year olds


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