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' FAMILY INFORMATION FORM <br />LAST NAME ArO ADDRESS (�",.. Zl u•d' . <br />P140HE NUHBERS (home)_� (Huabaad, work) .. .:.'(Wife work) <br />._... .. .:.1 ... . . .. .... :: <br />FAMILY MEMBERS:' . <br />lAdult(s) Name am .. _ • •.. j_�•. - <br />..._, is � .Name ,yJ'�f�j. <br />Child(ren) Nam rQ0 a Birth Datela"{g�hotol�d�j R 9 Grade 1� <br />Nam e1 d Birth DateZ 4-9 6chool Grade= <br />Name Birth Date School - Grade_ , <br />Name • Birth.Dare School Grade_ - <br />Name Birth Date . School Grade <br />---------CONTACT.NAHE (IN CASE OF EMERGENCY) PHONE NO. - <br />II /�.. <br />L;`CO12 S:J,, U-put� <br />P�i(\4JYK"a UCxCSt 0I4bJi s=�i IS <br />Pleaserettirn t if F form to the Hounds Viev Parks and Racre"atioti;DeyaFtWeat if �-�rr• <br />you. are registering for a class this.aessioc or•iF•yom_plan on registering.in C <br />'--- Citj of Mounds View.__..---•-- �-:_�_._• •--,_�_�.__�_., --. -. <br />2401 Highway 10 I 17 <br />Carrler'Route-Sore <br />Hounds View.- MN 55112 --__� .__.__8ULK le <br />RAJX <br />PAIDt <br />ID., <br />Permit No. 4408{ <br />--- — -- St. Paul, 4 �, <br />Postal Patron ::� � nl <br />--.._.. �.:_ ... _ _..._.. ..... .... --._._..:........ .... .......... <br />