Community Leadership Team Registration
Mondays starting August 18th from 6:30 to 8:00pm.
First Name *
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Last Name *
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Age *
This class is for 15-20 year olds
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Phone Number *
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Email
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Parent/Guardian First Name
if under 18 years of age
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Parent/Guardian Last Name
if under 18 years of age
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Address
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City
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State
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Zip
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Contact Phone *
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Contact Email *
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Emergency Contact First Name *
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Emergency Contact Last Name *
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Emergency Contact Relationship
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Emergency Contact Phone *
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Allergies
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Medical Conditions/Learning Disabilities/Other helpful info
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