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* 1. Student Name

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* 2. Grade

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* 3. School

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* 4. Age

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* 5. Parent/Guardian Name

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* 6. Parent/Guardian Phone Number

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* 8. Emergency Contact Name

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* 9. Emergency Contact Relationship to Student

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* 10. Emergency Contact Phone Number

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* 11. Will the student be attending the workshop?

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* 12. Does the student have any accessibility needs, allergies, or relevant medical information we should be aware of?

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* 13. Please describe any accessibility needs, allergies, or medical information.

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* 14. Do you grant permission for Uniting Voices Lexington to photograph or record the participant during the workshop for promotional and educational purposes?

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* 15. I acknowledge that I am registering my child for this free workshop and understand that Uniting Voices Lexington will supervise all activities.

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* 16. Parent/Guardian Signature (typed name)

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* 17. Date

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