PAL Registration Form

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PAL Registration Form

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* Indicates required question

Name (Last, First) *

Your answer

Date of Birth *

MM

/

DD

/

YYYY

Gender *

Male

Female

Other:

Race/Ethnicity *

American Indian or Alaskan Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

White

Address *

Your answer

City *

Your answer

School *

Your answer

Guardian Name *

Your answer

Guardian Phone Number *

Your answer

Emergency Contact Name *

Your answer

Emergency Contact Phone Number *

Your answer

E-Mail Address *

Your answer

Medical Conditions

Your answer

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