Has the Participant ever attended a Sow A Seed program? (check all that apply) *
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Participant's Age (ages 14 -18 only) *
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14
15
16
17
18
Participant's Birth date (type in correct year) *
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DD
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YYYY
Participant's School Name *
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Home Address *
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City *
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Acampo
Charming
Escalon
Lathrop
Lodi
Manteca
Mountain House
Ripon
Stockon
Thornton
Tracy
Woodbridge
Other ( if "Other" please list below)
If "Other" City, please list here
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Zipcode *
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Contact Phone Number (ie. xxx-xxx-xxxx) *
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Other Phone Number (ie. xxx-xxx-xxxx)
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I give permission for the participant listed above to Fresh Start Thinking. I also waive, release and discharge all claims for personal and property damages arising from my child's participation *
Required
Parent/ Guardian Name ( First, Last) *
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