Math SEAL Boot Camp
(To Be Completed by Parent/Guardian)
Email address *
1. Youth’s Full Name *
2. Today's Date *
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3. Parent/Guardian Name *
4. Relationship to Youth *
5. Address (street, city, state, zip): *
6. Home Phone: *
7. Work Phone: *
8. Cell phone: *
9. Youth's Age: *
10. Youth's Date of Birth: *
MM
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DD
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YYYY
11. Youth's School Grade: *
12. Youth's Gender: *
13. Youth's Ethnicity:
Clear selection
14. School: *
15. Emergency Contact Name: *
16. Emergency Contact Phone Number: *
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