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2023-2024 Youth on Wednesday Registration
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Email
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Your email
Student Name
*
Your answer
Student Date of Birth
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/
DD
/
YYYY
Student Grade
*
Your answer
Parent(s) or Guardian(s)
*
Your answer
Current Address
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Main Phone Number
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Your answer
Secondary Phone
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Parent or Guardian E-mail
*
Your answer
Emergency Contact Name (The emergency contact needs to be someone other than a parent of guardian.)
*
Your answer
Emergency Contact Phone Number
*
Your answer
Are you interested in being a Table Leader?
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