STARS

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* Indicates required field

Child Name *

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Last

Child's Age and Grade *

Youth T-Shirt Size *

Parent/Guardian *

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Last

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact *

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Last

Phone Number *

Allergies or Medical Conditions we should be aware of *

I give permission for my child to participate in the STARS after school program sponsored by the First Baptist Church of Bar Harbor *

Date *

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