Nephew Registration 

"A Place Where Dreams Are Mandatory"

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Email *
Nephew Name: First , Last *
Date of Birth: *
MM
/
DD
/
YYYY
Phone Number: *
Do You Have A Dream? *
If Yes, briefly explain your dream:
If No, select 3 from the options below:
How much experience do you have in this field? *
Who do you live with?
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Emergency Contact Name: First , Last
Emergency Contact Phone Number:
Emergency Contact Relationship (Optional)
I agree to participate in the 12‑week FatherType program, either in person or on Zoom, and I understand that some sessions may be recorded and used for social media and marketing. I confirm that I have a personal dream or goal I am committed to working toward. I understand the importance of consistent attendance and will do my best to be present each week, and I understand that anything shared in the program will remain private except for the recordings I have agreed to. *
A copy of your responses will be emailed to the address you provided.
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