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Minichefs Club

Minichef's Schedule

Mini Chef's Kickoff: October 17
October 24
November 7
November 14
November 21
Parents Information:
Mother's (or guardian's) Name:*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail:*
Home Phone Number:*

Area Code Phone Number
Cell Phone Number:*

Area Code Phone Number
Father's (or guardian's) Name:*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail:
Cell Phone Number:*

Area Code Phone Number
Child's Information:
Child's name*
Child's age*
How did you hear about this program?
Emergency Contacts:
Full Name #1:*

First Name Last Name
Phone Number:*

Area Code Phone Number
Relationship to child:*
Does your child have food allergy?*

YesNo
Allergies:*
Membership Fee:

$125
Comments
Total

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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