Student Information Sheet

Student Name *

Program Level *

Student's Grade *Student's current grade

Student's T-shirt Size

Student's School *

Food or other allergies - Please list:

Medical Conditions we should be aware of:

Student Date of Birth *

Requested Accommodations:

Guardian 1 Name *

Guardian 1 Phone Number *

Guardian 1 Email Address *

Guardian 2 Name

Guardian 2 Phone Number

Guardian 2 Email Address

Emergency Contact Name *

Emergency Contact Phone *

Relation to Student *

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