Contact & Program Information

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* 1. Student-Athlete's Full Name

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* 2. What gender is your child?

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* 3. Date of Birth
(Year/MM/DD)

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* 4. I am interested in registering for:

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* 5. What grade is your student-athlete in?

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* 6. Parent/Guardian Full Name

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* 7. Parent/Guardian email

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* 8. Parent/Guardian Cell #

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* 9. Parent/Guardian alternate phone #

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