UUS:E RE Registration 2017-2018
Child Information
First Name
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Last Name
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Date of Birth
MM
/
DD
/
YYYY
Grade Level in Fall 2017
Gender Identity
Do we have permission to use this child's image without their name in photos and videos pertaining to UUS:E and its programs?
Are there any allergies or other concerns we should be aware of? This information is confidential. If there are none, please write "none" in the space below.
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Street Address
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City
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State
Zip Code
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