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Youth Quake 2023

Full Student Registration Form

Student Information

First Name

Gender

Male

Female

Province

Email Address

Grade

Last Name

Address

Postal Code

Phone (Primary)

Name on Health Card

Date of Birth

Town

Country

Phone (Cell)

Health Card Number

Parent/Guardian Information

Parent/Guardian First Name

Phone/Emergency Contact

Parent/Guardian Last Name

Relationship to Student

Any food allergies we need to know about?

Additional Info

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Thanks for submitting all the information we need!

Lakeview Gospel Centre

4801 54 Street
Bonnyville, AB
T9N 1Z1

780-826-5150
info@lakeviewgospel.ca

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