2019 Boscov's and UHS Halloween Candy Exchange - This program is for children (ages 14 and under) with diabetes or food allergies. Registration form must be received by Wednesday, October 30, 2019. All information will be verified.

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* 1. First Name

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* 2. Last Name

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* 3. Address

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* 4. Age of Child

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* 5. Physician Name

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* 6. Physician Address

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