Dwight-Englewood School World Game Registration 2018
Monday, January 22, 2018 at the Dwight Englewood School, 315 East Palisade Ave., Englewood, NJ 07631
Student Information
First Name *
Your answer
Last Name *
Your answer
Gender *
Current School District *
Current Grade *
Date of Birth *
MM
/
DD
/
YYYY
Parent or Guardian Information
Name(s) *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
xxx-xxx-xxxx
Your answer
Other Phone Number (in case of emergency) *
xxx-xxx-xxxx
Your answer
E-mail Address *
Your answer
Permission
I shall indemnify hold harmless and defend the Dwight-Englewood School its officers and employees against liability arising from my child's participation in the World Game. *
Does your child have an allergies that we should know about? *
Your answer
Images *
Pictures of students will be taken during the World Game and used for promotional materials.
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