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The Fellowship of Claremore
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Student's Name (
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Student's Phone Number
We will only contact your student about upcoming events or youth updates.
Allergies or Medical Info (
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Student's Birthday (
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Grade Currently In
Emergency Contact (
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In the event of an emergency, who do we contact?
Emergency Contact Phone Number (
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Authorized Pickup (Other than parent/guardian
Student Pickup Authorization (Non-Family)
We understand that, at times, student may need to leave the program with another student or family. For this reason, students will only be permitted to leave the building with another student if a parent or legal guardian provides written authorization in advance.
What other student or family may your student leave with?
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