Braeswood Assembly of God

New Student Registration

Student Information Form

page 1 of 1

Student Name


First Name	Last Name

Birthday

Grade

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Allergies/Medical Conditions

Address

Parent / Guardian


First Name	Last Name

Phone

Phone Number

Email Address

As this child's parent/guardian, I consent to the use of photography for publication, broadcasting and media use.

Date

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Date *

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* required