Registration Form for Celebrate Spring Program

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Child's Last Name *

Child's First Name *

Child's Grade Level *

Parent/Guardian 1's Info *

Please list full name and contact info (personal and work)

Parent/Guardian 2's Info (enter N/A if not applicable) *

Please list full name and contact info (personal and work)

Parent/Guardian Email Address *

This is the email address to which we will send a confirmation email and Program Welcome Letter.

First Emergency Contact *

Please list full name and contact info (personal and work)

Second Emergency Contact *

Please list full name and contact info (personal and work)

Please share with us any information that would be helpful in providing for your child's needs. *

This includes medical concerns such as allergies or asthma, etc. Enter "none" if no concerns.

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