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School Student Flu Clinic Fees

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After submitting your payment, please return to the registration page to complete registration.

Price$20.00

Child's Full Name*

sm_tbcfC146511Child's Full Name is required.

School*

sm_tbcfC146512School is required.

Grade*

sm_tbcfC146513Grade is required.

Parent/Guardian Name*

sm_tbcfC146514Parent/Guardian Name is required.

Phone Number*

sm_tbcfC146515Phone Number is required.

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