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Starting October 15

For Bloomsburg Elementary Students (K-5th)

Thursdays from 3:30 to 5:30pm at Emanuel Fifth Street Bible Church

Online Registration

Student Name*

Parent/Guardian Name*

Parent/Guardian Email*

Parent/Guardian Phone*

Current Grade*

Allergies*

Emergency Contact Person*

Emergency Contact Phone*

How will your child arrive at Kindling?*

Pickup Personnel*

Questions

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EmanuelDHBC@gmail.com

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