Front Rush

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General

Member First Name *

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Member Last Name *

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Date of Birth

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Member Email Address

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T-Shirt Size

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Expected High School Graduation Year

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Profile Image

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Favorite Sport

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Parent/Guardian First Name

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Parent/Guardian Last Name

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Parent/Guardian Address

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Parent/Guardian City

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Parent/Guardian State

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Parent/Guardian Zip

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Parent/Guardian Phone Number

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Parent/Guardian Email Address

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How did you hear about Kids Club?

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If Other

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Photo Release

Yes

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See photo disclaimer on the previous page

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