Student Info- Middle & High School

Student Name

First Name

Last Name

Student Email Address

Would you like to receive email updates?

Yes

No

Student Phone Number

Would you like to receive text updates?

Yes

No

Address

Address 1

City

ZIP / Postal Code

State / Province

Country

Birthday

Favorite Snack

What school do you attend?

Parent Name

First Name

Last Name

Parent Email

Would parent like to receive email updates?

Yes

No

Parent Phone Number

Would parent like to receive text updates?

Yes

No

Anything else you want us to know?

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