LIHT Program Sign Up Form
We are asking for a ONE TIME registration fee of $40 to cover the cost of supplies and materials and snacks for the students please:
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Name of parent *
Parent email *
Parent number *
Child name *
Child age *
Child number (if they have one)
Any emotional or mental health concerns for child?
Emergency contact name
 *
Emergency contact number
 *
Who will the child be released to?
 *
Did you pay for sign up through the above link?
 *
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