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PLEASE complete BOTH sides of this form RIVER OF LIFE UMC CHILD AND YOUTH REGISTRATION 20132014 CHILD NAME (LAST) (FIRST) (MIDDLE) Child's Birthdate / ALLERGIES: (If no allergies PLEASE STATE NONE)
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2013 2014 UMC CHILDS Elem ACTIVITES Birthdate CURRICULAR HS custodial Pre enrollment incurred deem youths considerations BAPTISM Pediatrician SIBLINGS BAPTIZED

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