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Youth Group Halaqas Registration Form Student First Middle Last Gender Male Female School Name Grade Birth date // Age Street Address Town/City State Zip code Cell phone Youth Group of Interest Middle School Group College Girls Group Parent/Guardian - Contact Information Cell phone E-mail Emergency Contact Information Alternate Pickup/Release First Name Last Name Home Phone Work Phone Please circle how you heard about the Youth Group Halaqas BIS Website Word of Mouth Flyer Facebook Other...
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