Fusion Registration
Student Name (*)
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Home Address
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Birthdate (MM/DD/YYYY)
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School Name
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Grade for 2011-2012 School Year
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Allergies or other conditions we should be aware of (food reactions, physical limitations, ADD/ADHD, etc):
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I grant Hanover Community Church the right to photograph my child and the right to use such photographs, videos and reproductions with or without name or with a fictitious name, in any manner in connection with the advertising program of Hanover Community Church. I waive all right of inspection and approval, and release Hanover Community Church from any and all liability arising out of exercise of the rights hereby granted.
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Please complete the following information for any of the contact methods we may use to communicate with you about Fusion events:
Student Email
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Student Cell #
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Can we text student?
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Student on Facebook?
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Parent 1 Name
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Parent 1 Email (*)
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Parent 1 Cell #
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Can we text Parent 1?
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Parent 1 on Facebook?
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Parent 2 Name
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Parent 2 Email
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Parent 2 Cell #
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Can we text Parent 2?
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Parent 2 on Facebook?
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Home Phone #
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