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eNKouraged, LLC Christmas Arrival Information
Please fill this form out with all the information you have to date about Christmas 2021. We will reach out to you with more information/your tailored schedule prior to Christmas Break. Please e-mail
natasha@enkouraged.com
with any questions.
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* Indicates required question
Student Name
*
Your answer
Student E-mail Address
*
Your answer
Student Phone Number
*
Your answer
Guardian Name (School Representative, Guardian or Parent)
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Your answer
Guardian E-mail Address
*
Your answer
Guardian Phone Number
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Your answer
What grade/year is the student?
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9th
10th
11th
12th
PG
What school does the student attend?
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Your answer
When does the student's break begin?
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Your answer
When does the student's break end?
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Your answer
Does the student need transportation?
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Yes, transportation from the school AND back to school
Yes, just transportation from school
Yes, just transportation back to school
No transportation needed at all
I'm not sure yet, please e-mail me
Other:
Is the student vaccinated?
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Yes
No
Does the student have any medical concerns/needs (takes any daily meds)?
*
Your answer
Does the student have any dietary restrictions?
*
Your answer
What is the student's gender?
*
Female
Male
Prefer not to say
Other:
Please add any questions/concerns/additional information here.
Your answer
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