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Child Information
Child First Name
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required
Child Last Name
*
required
Preferred name/Nickname
Child Gender*
Male
Female
Child Birth Date
*
required
(mm/dd/yyyy)
Is this your child's first Baby & Me class?*
Yes
No
Are one or both parents Member(s) of Wilshire Boulevard Temple? *
Yes
No
Parent Information
Parent 1 First Name
*
required
Parent 1 Last Name
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required
Relationship to child
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required
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Mother
Father
Grandmother
Grandfather
Guardian
Parent 1 Cell Number
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required
Parent 1 Email
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required
Address 1
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Unit or Apartment No.
City
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State
*
required
Zip
*
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Second Parent Information
Parent 2 First Name
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required
Parent 2 Last Name
*
required
Relationship to child
*
required
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Mother
Father
Grandmother
Grandfather
Guardian
Parent 2 Cell Number
*
required
Parent 2 Email
*
required
Address same as Parent 1?*
Yes
No
Address
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required
Unit or Apartment No.
City
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required
State
*
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Zip
*
required
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