DREAM PUSHER ACADEMY (*TEENS ONLY AGES 13-18) 
DREAM PUSHER ACADEMY will be hosting FREE TEEN WORKSHOPS/EVENTS. Please complete the questions below. Upon completion you will receive a letter of acceptance and confirmation. We are looking forward to working with your teen this year!  PLEASE NOTE: SOME EVENTS ARE OPEN TO YOUNG ADULTS UP TO AGE 21.

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FIRST NAME OF YOUNG SCHOLAR *
LAST NAME OF YOUNG SCHOLAR  *
YOUNG SCHOLAR GRADE LEVEL  *
NAME OF SCHOOL ATTENDING (include City & State) *If Graduated List University or College) *
EMAIL ADDRESS OF YOUNG SCHOLAR  *
PHONE NUMBER OF YOUNG SCHOLAR OR PARENT/GUARDIAN *
FULL NAME OF PARENT/GUARDIAN (*18 and under ONLY)
EMAIL ADDRESS OF PARENT/GUARDIAN (*18 and under ONLY) 
EVENT/SESSION LOCATION (PREFERENCE):  *
INTERESTED IN: (*select at lease one)   *
Required
Mailing Address (***BOOK CLUB ONLY TO SHIP BOOK)
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