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A.P.M Registration Form
Thank you for choosing Acknowledge Positve Movements. By completing this form you are agreeing that : (1) You are over the age of majority in your jurisdiction of residence. (2) You are registering on behalf of a minor and are his/her parent/legal guardian and as such are fully authorized and entitled to enter into agreement on his/her behalf. Please note this agreement requires you to read the Program Agreements on our website.
PARENTS INFORMATION
Primary Contact First Name
Your answer
Primary Contact Last Name
Your answer
Adress
Your answer
Phone #
Your answer
Cell Phone #
Your answer
Email
Your answer
Secondary Contact First Name
Your answer
Secondary Contact Last Name
Your answer
Adress
Your answer
Phone #
Your answer
Cell Phone #
Your answer
Email
Your answer
PARTICIPANTS INFORMATION
First Name of Child
Your answer
Last Name of Child
Your answer
Address
Your answer
Date of Birth
MM
/
DD
/
YYYY
Age
Your answer
Gender
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