RESERVE YOUR SPOT FOR CBC 7TH GRADE CHALLENGE DAYS!
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Student First Name *
Preferred Name
Student Last Name *
Suffix
Student Date of Birth
(mm/dd/yyyy)
School
Parish/Church
Student Address
City
State
Zip Code
Parent Information
Parent/Guardian Name *
Parent Cell Phone *
(In case of emergency)
Parent E-mail *
Challenge Day Dates - Additional Date Added:  *
Favorite Academic Subjects
Co-Curricular Interests
(Fine & Performing Arts, Athletics, STEM, Clubs/Organizations, etc.)
Requests and Additional Notes (example: John would like to sit with Friend 1, Friend 2, etc.)
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