Achieve To Dream Student Information
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Email Address/ Dirección de Correo Electrónico *
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Student First Name/ El Primer Nombre del Estudiante *
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Student Last Name/ Apellido del Estudiante *
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Address/ La Dirección
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City/ La Cuidad *
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State/ El Estado *
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Zip Code/ El Código Postal *
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Parent Name/ Nombre de los Padres
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School (Optional)/ La Escuela (Opcional)
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I agree to allow Achieve To Dream and all persons related to Achieve To Dream permission to provide educational support for the listed student. By electronically signing, your signature will be considered as an actual signature. Please sign below to allow Achieve To Dream the ability to provide support for your student. *
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I give permission to Achieve To Dream to take pictures, motion pictures, video tape, or live television pictures, or otherwise record, reproduce, or depict the activities of any and all Achieve To Dream sponsored events and activities, used for same publication, including television release and theater viewing, website and social media site, without compensation to me or anyone or any entity acting on my behalf , or individuality. *
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