CVSU Afterschool 2019-2020 Summer Registration
Student First Name *
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Student Last Name *
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Student's Date of Birth: *
MM
/
DD
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YYYY
Student's Mailing Address: *
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Student's School for the 2019-20 school year: *
Name of Parent/Guardian: *
Your answer
Parent's Mailing Address (if different from Student's):
Your answer
Parent's Home Phone:
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Parent's Cell Phone:
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Parent's Work Phone:
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Parent's Email Address:
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2nd Parent/Guardian's Name (if applicable):
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2nd Parent/Guardian's Address (if different from Student's):
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2nd Parent/Guardian's Home Phone:
Your answer
2nd Parent/Guardian's Cell Phone:
Your answer
2nd Parent/Guardian's Work Phone:
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2nd Parent/Guardian Email
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