**NOTE
One Time full registration is required. Entry will be denied if initial registation is not found in the system.
Did you ever complete the full registration for this program?
*
Yes
No
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Select the Date
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Student's Full Name
*
First Name
Last Name
Student's Phone Number
*
E-mail (Non-School)
*
example@example.com
Grade
*
Please Select
6th
7th
8th
9th
10th
11th
12th
Gender
*
Please Select
Male
Female
School Name
*
School District
*
Mother Full Name
*
First Name
Last Name
Mother Phone Number
*
Mother E-mail
*
example@example.com
Father Full Name
*
First Name
Last Name
Father Phone Number
*
Father E-mail
*
example@example.com
Authorized Pickup
*
Mother (as mentioned above)
Father (as mentioned above)
Other (Mention Relation to the child))
Relation to the child
*
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Mandatory Pickup/Dropoff Policies and Procedures
*
Consent & Acknowledgement
Please fill all the required fields
*
How did you hear about us?
*
Please Select
Word of mouth
Mom Whatsapp Group
Instagram
Attended a previous Gem event
Email
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