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Online and Onsite Music, Art & Dance Classes
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Home
Register
Payments
Contact Us
Donate
Events
Art
Dance
Music
Rock Band
Faculty and Staff
Video Archives
Diversity
Summer Children’s Choir
Medical Emergency Form
Medical Emergency Information
Prove You Are A Human: What is 2 + 4?
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Student Name
*
First
Last
List any medical problems your child has:
List any medications your child will need while at Fanfare:
List any allergies that may cause your child difficulty (such as foods, bees, etc):
Parent/Guardian Name:
*
First
Last
Emergency Contact Name:
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First
Last
Emergency Contact Phone:
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Who will be bringing and picking up your child?
*
Email
This field is for validation purposes and should be left unchanged.