Please Print
|
Name |
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| Address | |
| City: | |
|
Zip:* |
|
| Birth date | |
| School | |
|
Grade |
|
| Previous JO Club | CLUB YEARS NA |
| Mom's Name/Tel # | |
| Dad's Name/Tel # | |
| Cell Phone | |
|
Email: |
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| If your child has any emergency condition please fill out the Emergency Release form | |
| EMERGENCY TEL NUMBER* | |