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Parent Last Name *
Parent First Name *
Email Address
Street Address *
City *
State/Province *
ZIP/Postal Code *
Contact Phone 1 *
Emergency Phone *
Emergency Contact Name *
Emergency Contact Relationship *
Emergency Contact Phone *
From time to time AWC uses photos and videos of participants for publicity in brochures, newspapers and websites. Please indicate below if you give consent for the use of yours and your child's photo or video. *
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