Smith Valley Baptist Church
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1. Parent Information
2. Student Information
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Parent Personal Information
Parent First Name:
Parent Last Name:
Address 1:
Address 2:
City:
Country:
United States
Canada
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bangladesh
Belarus
Belgium
Belize
Bermuda
Bolivia
Bosnia and Herzegowina
Brazil
Bulgaria
Cayman Islands
Chile
China
Colombia
Costa Rica
Croatia (local Name: Hrvatska)
Cuba
Cyprus
Czech Republic
Denmark
Dominican Republic
Ecuador
Egypt
Finland
France
Georgia
Germany
Gibraltar
Greece
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Hungary
India
Indonesia
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Korea, Democratic People's Republic of
Kuwait
Malaysia
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Netherlands
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Norway
Pakistan
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Saudi Arabia
Singapore
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Slovenia
South Africa
Spain
Sweden
Switzerland
Taiwan
Thailand
Turkey
Ukraine
United Arab Emirates
United Kingdom
United States minor outlying islands
Uruguay
Uzbekistan
Venezuela
Yugoslavia
State:
AA (Armed Forces Americas)
AE (Armed Forces Europe)
Alabama
Alaska
American Samoa
AP (Armed Forces Pacific)
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
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Indiana
Iowa
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Kentucky
Louisiana
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Marshall Islands
Maryland
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Northern Mariana Islands
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Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip:
Email:
Re-Enter Email:
Home Phone Number:
(xxx-xxx-xxxx)
Cell Phone Number:
(xxx-xxx-xxxx)
Other Phone Number:
(xxx-xxx-xxxx)
Emergency Contact
Emergency Contact First Name:
Emergency Contact Last Name:
Emergency Phone 1:
(xxx-xxx-xxxx)
Emergency Phone 2:
(xxx-xxx-xxxx)
Alternate Pickup First Name:
Alternate Pickup Last Name:
Alternate Pickup Phone:
(xxx-xxx-xxxx)
Other Information
Home Church (If Applicable):