Pine Lake Registration

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Are you going to Pine Lake!? *

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# of additional guests *

Student Name *

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Parent Name *

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Contact Information *

Guest #1 - Name *

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Guest #2 - Name *

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Guest #1 - Parent Name *

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Contact Information *

Guest #2 - Parent Name *

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Additional Comments - Medical, Allergies, Other, or None *

201 N. 8th Street, PO Box 11, Upland, IN 46989 | (765) 998-2985