UUS:E RE Registration 2019-2020
Child Information
First Name *
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Last Name *
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Date of Birth *
Grade Level in Fall 2019 *
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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