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FOCUS Student Group
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* Indicates required question
Participant's First Name
*
Your answer
Participant's Last Name
*
Your answer
Participant's Phone Number
Your answer
Participant's Email Address
Your answer
Participant's Program
*
FOCUS Students at Barbour County High School (7th - 12th Grade)
FOCUS Students Bullock County (7th - 12th Grade)
FOCUS Students Tri-City (7th - 12th Grade)
FOCUS Students ATL (7th - 12th Grade)
FOCUS College and Young Adult Group (Ages 19-24)
Participant's Date of Birth
*
MM
/
DD
/
YYYY
Participant's Grade Level
*
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
First Year College
Second Year College
Third Year College
Fourth Year or Above College
Participant's School
*
If you are a young adult and not enrolled in a post-secondary institution, place
N/A
.
Your answer
T-Shirt Size
*
The following sizes are listed in adult format.
XS
S
M
L
XL
XXL
XXXL
Does the participant have any allergies or underlying medical conditions that would affect their participation in the program?
*
Your answer
Emergency Contact Information
Primary Contact's Name
*
Your answer
Relationship To Primary Contact
*
Your answer
Primary Contact's Phone Number
*
Your answer
Primary Contact's Email Address
*
Your answer
Secondary Contact's Name
Your answer
Relationship to Secondary Contact
Your answer
Secondary Contact's Phone Number
Your answer
Secondary Contact's Email Address
Your answer
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