Excellence in Reading and Fitness Certificate |
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Child’s Name (First, Last) |
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School |
Grade as of 6/08 |
Parent or Guardian Name (First, Last) |
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Address 1 |
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Address 2 |
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Phone/E-mail |
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Number of Days Completed. |
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Total Number of Points |
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To receive your certificate and be eligible for a medal, please have your parents complete the above form and send it with the attached calendar to:
Assemblyman Michael J. Cusick |
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