Impact Springfield Application
Please fill out the application form below (one per family), indicating any special circumstances in the space provided.
First and Last Name
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Age
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Contact Information
Email Address
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Phone Number
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Are you on Facebook? If yes, name it is listed under
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Please enter your full address
Street
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City
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State
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Zip Code
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Additional Information
Names of additional family members attending, their age, and special circumstances (if any)
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Emergency Contact Name
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Emergency Contact Phone Number
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Please describe any physical or dietary limitations
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It is Extend Global's Policy for team members to abstain from alcohol, vaping, tobacco, and illegal drugs during the mission. Please check one statement below
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