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FSM D-Group Registration-Benton Campus on Wednesday, August 15, 2018 @ 6:00 PM

Please provide the information below as a part of your registration. 
*Student's Name:
*Student's Gender:
*Student's Grade:
*Student's School:
*Student's Date of Birth (MM/DD/YYYY):
*Student Phone Number:
I'd Like To Be With These Students (First & Last Name):
I'd Like To Be With This Leader:
When Do You Prefer To Meet?:
*Parent's Name:
*Parent's Email:
*Parent's Phone Number:
Have A Child That Requires Special Assistance?: