Jackson Hole Leadership PHASE III Application
Contact us at (307) 733-6440 or leadership@tyfs.org
Email address
Child's Name
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Date of Birth
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Age
Grade in School (Fall 2017)
Mailing Address
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Parent(s) Name(s)
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Email
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Best Contact Phone #
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Alternative Phone #
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Please Check all that apply
Does your child have any dietary restrictions? If yes, please explain.
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What sports/ physical activities does your child participate in?
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Are there any concerns you would like to bring to our attention?
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Does your child have a history of emotional, behavioral, family or school issues that you would like to discuss with a program leader prior to your session so that we can best support your child's needs?
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Payment
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