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Group Registration

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  Parish Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parish Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Group Leader's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Group Leader's Email REQUIRED Please fill out this field. Please enter an email address.
  
  Group Leader's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Number of Youth Attendees REQUIRED Please fill out this field. Please enter an integer (number).
  
  Youth Attendee Cost20.0
  
  Number of Adult Chaperones REQUIRED Please fill out this field. Please enter an integer (number).
  
  Adult Chaperone Cost10.0
  
  I have read and will comply with all requirements of ACYC Jr. Registration guidelines.
  [Type full name below to indicate signature.]
  
  FULL NAME REQUIRED
  This indicates your acceptance of the above declaration.
  Please fill out this field. Please enter valid data.
  
  Total:
  
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