Registration Form using PayPal

Student's Name:*
Student's 2 Name:
Age:*
School:*
Grade:*
Teacher:
Parent/Guardian Name:*
Address:*
Home Phone:*
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Cell Phone:*
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E-mail:*
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How did you hear about this program?:
It is okay for my child to appear on promotional materials such as website, flier and brochures. Also as a parent or guardian I also give my consent to use my written or verbal testimonial regarding the program:*
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