FAME: 48 Hour Musical Challenge: Graham Academy, Nov. 8-10, 2018
Student First Name *
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Student Last Name *
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Student Date of Birth *
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Student Age as of December 31 *
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School attending this year *
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Grade *
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Street Address *
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City *
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Province *
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Postal Code *
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MCP: *
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Will the participate be staying overnight on Nov 8 & 9th?
As meals will be provided, are there any dietary restrictions or allergies that require our attention?
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Primary Contact/Guardian Name *
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Primary Phone *
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Primary Contact/Guardian Cell Phone *
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Other Phone
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Email Address *
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Alternate Contact Name *
In case of emergency and the parent/guardian cannot be reached.
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Alternate Contact Phone Number *
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Does your child require accommodations in any areas. (ie. physical disabilities, learning disabilities, special needs, etc.) that you wish to confidentially disclose in order for the Graham Academy team to provide appropriate support? *
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