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2019 Teen Winter Retreat
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First Name
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Last Name
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Address
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(Street, City, State, Zip)
Phone
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(xxx-xxx-xxxx)
Email
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(To receive confirmation of registration.)
Gender
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Male
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Date of Birth
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(DD/MM/YY)
Grade
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7th
8th
9th
10th
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Home Church
Parent/Guardian Name(s)
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Emergency Contact Person
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Emergency Contact Person'sPhone
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(xxx-xxx-xxxx)
Medical / Personal Notes
Having read the CLAY Winter Retreat Brochure, I agree to allow my youth to attend. I relinquish New Life Church, Abba's Haven, volunteer workers and anyone associated therein of any liability described within the brochure.
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