HCV Digital Inclusion Class Registration

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Parent/Guardian Information

Parent / Guardian First Name *

Parent / Guardian Last Name *

Parent Phone Number *

Parent Email *

Preferred Contact Method *

Phone

Text

Required

Address *

City *

State *

Zipcode *

How did you hear about us? *

HCV Email Blast

HCV Social Media

Word of Mouth

LevelUp412

Other:

Does your child have a laptop or tablet? *

Yes

Other:

Does your home have internet service? *

Yes

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