The PULSE Program
Application for Enrollment
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Student Name (Last, First) *
Student's Current School *
Student ID #
Parent/Guardian Name *
Primary Phone Number *
Student Interests *
Please list any activities/hobbies that your student would be interested in participating in during their time in the PULSE Program. Our goal is to use student feedback and interests to shape our program and meet the needs of your student/s. (Please list)
By Signing this application you hereby grant permission for your student to participate in all activities of the Visalia Unified PULSE After School Program *
Student Name
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