Level Up STUDENT Registration Form

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GAOG Level Up 2020

Email *

Name of Student *

Grade/Academic Level *

Date of Birth *

YYYY

Name of Parent/Primary Contact *

Email (Parent/Contact) *

Telephone # (Parent/Contact) *

Key subjects student needs assistance with *

Academic goals for the year *

My signature below indicates that I am the parent or legal guardian of the students named above hereby grant to GAOG permission to use the names, likenesses, photos, and videos of myself and the named students in its communications and publications, including web-based publications and also for any other legal purposes.

Yes

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Sign and Date (Type name and today's date)

Send me a copy of my responses.

Submit

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