College / Private School
Shipping Home
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Parents/Guardians Name:
 *
Students Name:
 *
Street Address:
*
City:
 *
State:
 *
Zip Code:
 *
Parents Phone #:
 *
Parents Email Address:
 *
Name of College/School Attending:
 *
Date Student Returns Home:
*
MM
/
DD
/
YYYY
Additional Insurance Amount: (Each package comes with $100 insurance).
Additional information/Comments
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