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Name: __________________ School: ____________ Grade: _______ Shirt Size: ____ Address: __________________________ City: ____________ State: ___ Zip: _____ Phone #: __________________________ Emerg. Phone #: ____________________ Parent/Guardian: ____________________ Parent Email: _______________________ I give permission for ________________ to attend the Campus Life trip during spring break from March 30 (leave at night) - April 5, 2013. _________________________________ Parent/Guardian Signature! ! ! _________________________________ ! ! Date

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