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Dover Teen Center Registration Form
Completion of this form allows your child use of the center as well as the ability to participate in any center-sponsored programs and activities
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How did you hear about the Dover Teen Center?
Your answer
Youth Participant Name
Your answer
Participant Birthdate
MM
/
DD
/
YYYY
Participant Age
Your answer
Participant Home Address
Your answer
Participant School
Dover Middle School (DMS)
Dover High School (DHS)
Other:
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Participant Grade
6th
7th
8th
9th
10th
11th
12th
Other:
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Home Phone Number
Your answer
Participant Email
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Participant Cell Phone Number
Your answer
Does the participant have their COVID-19 vaccination?
Yes, fully vaccinated
Only 1st dose
No, not vaccinated
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We
STRONGLY ENCOURAGE
all youth participants to be fully vaccinated. Thank you!
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