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Visiting Student Liability & Photo Release
Fill out this form carefully prior to your student's visit to Dan & Cassidy Towriss IDEA Space KC.
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Student First Name
*
Your answer
Student Last Name
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Your answer
Student Date of Birth
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DD
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YYYY
Student Gender
*
Your answer
School Student Attends
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Your answer
Current Grade
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Your answer
Parent/Guardian First Name
*
Your answer
Parent/Guardian Last Name
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Your answer
Address
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Your answer
Parent Email
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Your answer
Phone Number
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Your answer
Emergency Contact Name
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Your answer
Emergency Contact Phone Number
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Your answer
Would you like to be added to our contact list for information about future after-school and summer learning opportunities?
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