Summer Registration Form
Complete form for each Student you are enrolling into Summer Programming
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Student Name *
Student Age *
Students Must be 8 - 15
Student Grade *
Grade as of 2022-2023; Grades 4 - 8 Only
Any Allergies MEN Inc should be aware of? *
"NKA" if there are No Known Allergies
Parent (Guardian) Name *
Address *
Preferred Contact Number *
Preferred E-Mail Address *
Emergency Contact *
Additional Contact other than Primary Parent  or Guardian
Emergency Contact Phone Number *
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