Crazy Science Registration | ANCC

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Crazy Science Registration Form

Registration is $15 to secure your child's spot.

Child Name

Child's Date of Birth

Child Age

Primary Parent Name

Child Grade

Primary Phone Number

Email

Address

Emergency Contact 1

Emergency Contact (1) Phone Number

Known Allergies

I hereby certify that the information provided is true and to the best of my knowledge.

Your Signature

Today's Date

Thanks for submitting!

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