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Registration Fee Clay-Platte Montessori School - Summer Enrollment Form Child s Full Name DOB M/F month day year Address Street City State Zip Home Phone Grade last completed Sponsor Name Herein after Parent Address if different from above Employer/Occupation Work Phone Cell Phone Authorized to pick up Name Relationship Phone Do we have permission to contact your Doctor in an emergency Y / N Physician s Name All Allergies Special physical social medical or emotional information you feel...
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