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HSM Beach Day on Tuesday, August 5, 2025 @ 1:00 PM

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15.00
$15 registration fee 
Please provide the information below as a part of your registration.
*Gender:
*Grade Level:
*Birthdate:
*Insurance Company:
*Policy Number:
*Group Number:
*Special Needs or Medication:
Please Explain special needs and medication:
*Allergies (food, drugs, etc); Please include dietary restrictions since we will provide dinner:
*Health Conditions or Physical Limitations:
Home Church:
*Parent/Guardian Name(s):
*Parent/Guardian Address(es):
*Parent/Guardian Phone Number(s):
*Parent/Guardian Email(s):
*Emergency Contact (other than listed parent/guardian):
*Emergency Contact Phone Number:
*Will your child be riding the bus with us?:
NOTE: We ask that students do not drive other students unless they are siblings.
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