Brook Kids NORTH | Information Card
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1st-Time Guest
Regular Attender
Member
Campus
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Fallbrook North
Child(ren) Information
Please type in your Child's Name, Gender, Date of Birth, Age & Grade Below
Child 1 Name, Gender, DOB, Age & Grade
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Child 2 Name, Gender, DOB, Age & Grade
Child 3 Name, Gender, DOB, Age & Grade
Allergies
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Allergies | Child's Name
Special Needs
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Yes | Special Buddies
No
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Yes | Special Buddies
No
Special Needs | Child's Name
Parent(s)/Guardian Information
Parents Name
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Date of Birth
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Mobile
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Email
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Parents Name
Date of Birth
Mobile
Address
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Email
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Contact Phone#
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Description
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