SRP 2015 Registration - Wednesdays - Grades 9-12 10:30am
Registration form must be completed for each individual child attending.
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Teen's Last Name, First Name *
ex. Johnson, Abigail
Teen Phone (if applicable) *
ex. 555-555-5555
Parent/Caregiver Last Name, First Name *
ex. Johnson, Abigail
Parent/Caregiver Phone *
ex. 555-555-5555
Parent/Caregiver Email *
Emails will be used to contact patrons regarding programs ONLY and will not be shared with any third parties. Type N/A if you do not have an email address
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