ALOHA Summer Application
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Email *
Email Address
Child's Full Name
Child's Current Grade Level
Child's Current School
Child's DOB
MM
/
DD
/
YYYY
Parent/Guardian Name
Parent/Guardian Cell Number
Emergency Contact Name
Emergency Contact Number
Street Address
Please specify any other medical conditions, allergies, medications, or disabilities
If transportation is provided within a 5 miles radius, would you need it?
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What would you like your child to get out of this summer experience?
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