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YES!  I would like to part of the ALL STARS!
To be a part of this exciting program, just print out and fill out the information on the ALL STARS form.  Send to:
Malinda Riley
Valley Community Coalition
P.O. Box 181
Clermont, Iowa 52135

Questions? Contact Malinda Riley

Youth Coordinator - Malinda Riley - 423-5171
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Parent's Names

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Child's Name

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Address

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Phone

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Child's Age                                              Grade


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Parent Signature                                                             Date