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VSSL Connect Registration - Strong4Life
This form is for parents to fill out to sign up their teens for VSSL Connect.
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* Indicates required question
Participants Legal Name (First + Last)
*
Your answer
Preferred Name (if different than above)
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Female
Male
Prefer not to say
Other:
Preferred pronouns
Your answer
Participant Phone #
*
Your answer
Participant email address
*
Your answer
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name (1) (First + Last)
*
Your answer
Parent/Guardian Phone # (1)
*
Your answer
Parent/Guardian Name (2) (First + Last) (if applicable)
Your answer
Parent/Guardian (2) Phone # (if applicable)
Your answer
Parent/Guardian (2) email (if applicable)
Your answer
If the Parent(s)/Guardian(s) above are the emergency contact, click YES. If NO, please fill out emergency contact questions below.
*
Yes
No
Emergency Contact Name (First/Last)
Your answer
Emergency Contact Phone #
Your answer
Emergency Contact Email
Your answer
Is there anything the teen would like us to know about them before group begins?
Your answer
We will review your registration and be in touch within 72 hours of submission. Thank you!
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