Tech Bridge with Gideon's Army
For 3rd - 8th grade Girls 
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Email *
Student First Name *
Student Last Name *
City *
State/Province *
Student Date of Birth *
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Gender of Student *
Required
Parent/Guardian Name *
Parent Email *
Address *
Phone number
Allergies
School attended grade *
Student will attend all days of program from 8am to 12pm (4hours) as health permits. Student is expected to follow code of conduct, school rules, program rules (to be shared first day) and treat all other students, instructors and guest with respect.   I give organizing Parties permission to take and use photographs or recordings of Participant taken during an Activity and use and sublicense such material for any purpose in print, advertisements, films or videos and on line and broadcast presentations of any sort. *
Required
Emergency Contact *
Dietary  *
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