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Registra)on?Form
Registra)ons?can?be?made?by?mail?or?in?person?(cash,?check,?Visa/MC)?at?the?
Middletown?Arts?Center,??36?Church?Street,?Middletown?NJ??07748??
Registrant’s?name?___
Date?of?Birth___??Male___??Female___Grade___
Parent/Guardian___
Street?Address___
Town___State___?Zip___
Home?Phone#___
Cell/Alternate?Phone___
Emergency?Contact?(other?than?above)___
E?Mail?Address___
Please?note?special?needs/medical?concerns/allergies,?learning
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