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Last Name: Lei
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First Name: Amelia
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Middle Initial: C
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Address: 817 35th Ave. San Francisco CA 94121
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Home Phone:
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Cell Phone:
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Email Address:
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What Program or School are you volunteering with?
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What Grade are you in?
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Emergency Contact Name, Relationship, and Phone Number
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Privacy and Release Authorization
Please Sign and Date Below:
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Parent/Guardian Approval
Parent/Guardian Signature and Date Below:
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Agreement and Release From Liability
Parent/Guardian Signature and Date Below:
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Volunteer Signature and Date Below:
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