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Summer Survivor - Registration 2021
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Registrant Name (First/Last)
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Age
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Birthday
MM
/
DD
/
YYYY
School
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Entering what Grade in September?
10
11
12
Other:
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Please list your other three team members: (if you aren't sure who yet, or don't have three, just leave blank)
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Phone Number
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Primary Email (Please list one you actually check, as participant info will be sent by email)
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Emergency Contact Name
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Emergency Contact Phone Number
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Allergies/Medical Concerns? (Please specify)
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