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* 1. Are you interested in signing up for a Youth Improv Jam for ages 13-17?

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* 2. First and Last Name of Parent:

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* 3. First and Last Name of Student:

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* 4. Age of student:

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* 5. Contact E-mail Address:

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* 6. Contact Phone Number

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* 7. Can you be available Thursday from 5-7pm for this workshop for 12 weeks?  (It may have some breaks.)

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