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APPLICATION
Participate's first name
Participate's last name
Birthday
Age
Grade
School
Street Address
City
Region/State/Province
Postal / Zip code
Country
Country
PARENT INFORMATION
Parent/Guardian Full Name
Relationship
Address
Phone
Email
EMERGENCY CONTACTS
#1 Name
#2 Name
Phone
Phone
Relationship to Child
Relationship to Child
What describes you childs interest or needs?
Childcare
Tutoring
Aftershool program
Boys Basketball
Girls Basketball
Cheer/Dance
Drumline
Soccer
Transportation
Mentorship Program
Register Now
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