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* 1. Teen's Name (First and Last)

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* 2. Teen's Cell Phone Number

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* 3. Select your group below

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* 4. Teen's Age

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* 5. Teen's T Shirt Size

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* 6. Parent's Name

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* 7. Parent's Number

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* 8. Will you be fully vaccinated (both doses) before 2/11/2022?

T