GX Canada Application
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Your Name
First Name
Last Name
Your Cell
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Area Code
Phone Number
Email
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Age
Gender
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Female
Date of birth
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Month
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Day
Year
Parent Name #1
Full Name
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Phone Number
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Area Code
Phone Number
Email
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Parent Name #2
Full Name
Mother/Father/Guardian
Phone Number
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Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact
Full name
Relationship
Emergency Contact Phone
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Area Code
Phone Number
Allergies/Dietary restrictions
List any injuries or physical limitations
They are healed in Jesus name
Why do you feel called/intrested in GX Canada?
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Area of interest?
Dance Crew
Skateboarding
Tech Team
Rap
DJ
Graffiti
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