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Centershot Registration: Experienced

Participant Information
Participant's Name*
Date of Birth (if under 18)*
Male/Female*
Street Address*
City*
State*
Zip Code
Phone*
E-Mail*
Preferred class time (Please note that while we will do our very best to accommodate you, class preferences will be assigned on a first come first serve basis).
Are you planning to bring your own equipment?
Eye Dominance
When did you last attend a Centershot program?
Riverview Church has permission to take your child's picture for promotional reasons.
Would parents be willing to help with a snack?
Do you attend a local church?
Emergency Contact Information
Name
Phone
Relationship to Participant
Name
Phone
Relationship to Participant
Are there any dietary limitations, allergies, current medications or current medical conditions you would like us to know about?
If yes, please explain


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