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Get St. Timothy's Youth Ministry Minor Permission Medication Notification and Release Form

Ula Date: Monday, August 8, 2011 Leaving: 10am (from St. Tim’s) Returning: 8pm Cost: Money for your food (lunch and dinner)---$10-15 Participant’s Name ________________________________ Date of Birth_____________ Today’s Date______________ Parent Name_________________________________ Parent Email__________________________________________ Home Phone_____________________ Parent’s Cell _____________________ Student’s Cell_____________________ Address _________________________ City______.

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