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00 per child NO LATER than June 10 2017 For information call Maryellen at the Rectory or email dre strichardchurch. Org. Child name Age Grade in Sept. 2017 Parents/Guardians Names Address Home Cell Work MEDICAL/EMERGENCY/DISMISSAL INFORMATION Medical Issues Emergency Contact if parent is not available Relation to Child Cell Work Dismissal My child may be dismissed to the following people My child can walk home by his/her self Parent SignatureToday s Date Amount Paid. COME JOIN US June 19-23...
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