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NextGen Youth Leadership Academy Registration Form
This form will allows us to capture the student and parent/guardian's contact details and reason for joining.
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* Indicates required question
Student Name (First and Last)
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Your answer
Student Email
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Your answer
Student Phone Number
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Your answer
Date of Birth
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MM
/
DD
/
YYYY
Gender
*
Male
Female
High School
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Your answer
Current Year Level
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Your answer
Why do you wish to attend NextGen Academy?
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Your answer
Parent/Guardian Name (First and Last)
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Your answer
Parent/Guardian Email
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Your answer
Parent/Guardian Phone Number
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Your answer
Please list any medical conditions, allergies or special dietary needs
*
Your answer
I give NextGen Youth Leadership Academy permission to publish images/videos of myself/my student for promotional purposes (if you have any questions/concerns contact Danny Kettoola.
danny@nextgenleader.co.nz
0211128385).
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