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Full Name
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Phone Number
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Date of birth (mm/dd/yyyy)
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Have you been born again?
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Email address that you actually use:
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Will you need childcare, If so, how many children? Childcare available ages 1 year - 8 years old. First come, first serve. $5 per child.
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The intensive is $25. If no children, put $25 below. Add $5 per child:
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