Section 1 of 2
Empowerment Information Session
Please complete this form to register for the free information session.
Participant Name: (last, first)
Participant Name: (last, first)
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Participant Email:
Participant Email:
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Phone Number
Phone Number
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Age
Age
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School and Current Grade
School and Current Grade
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Section 2 of 2
Parent/Guardian information
Name: (last, first)
Name: (last, first)
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Email
Email
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Address
Address
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Phone number
Phone number
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I consent to allow photography of my child during events and use for marketing/promotional activities.
I consent to allow photography of my child during events and use for marketing/promotional activities.
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No
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Parent/Guardian Electronic Signature:
Parent/Guardian Electronic Signature:
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