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New Patron Form
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First Name *
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Last Name *
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Spouse Name
If applicable. If not, leave blank.
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Address *
Street, City, State, Zip
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Phone Number *
Please enter a phone number with area code (no parentheses or dashes).
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Email Address *
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Number of Children in Household *
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School District *
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Emergency Contact Name *
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Emergency Contact Phone Number *
Please enter a phone number with area code (no parentheses or dashes).
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How did you hear about us? *
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Did someone referred you to us?
If Yes, please write Name of person or Organization? If No, please write N/A
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Would you like to receive a monthly email and learn about special events? *
Can we notify you of special events via email? *
These emails would come once a month or less
Household Income
This information is strictly for grant reporting
Number of People in household
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