Jackson Hole Leadership PHASE II Application
Contact us at (307) 733-6440 or leadership@tyfs.org
Email address *
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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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