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Session Dates:

Age Range -

Attendee First & Last name

Attendee Age

Parent/Guardian Name

Parent/Guardian Phone Number

Any Allergies? If so, please specify

Any dietary restrictions (ex. vegetarian)?

Emergency Contact Name (must be different than the Parent/Guardian listed above) (optional)

Emergency Contact Phone Number (must be different than the Parent/Guardian listed above) (optional)

Other Authorized Person for Pickup (First & Last name) (optional)

Other Authorized Person for Pickup (phone number) (optional)

South Run Rec Center

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