Panda Club

 

Name of Parents: _________________________________________________

Name of Child: ___________________________ D.O.B:__________________

Name of Child: ___________________________ D.O.B:__________________

Name of Child: ___________________________ D.O.B:__________________

Country/Province of Origin___________________________________________

 

Address: _________________________________________________________

____________________ Telephone: (___)___________________

Email Address: _________________________

Comments: ________________________________________________________

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