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Student's Full Name*

First NameLast Name
Student's Phone Number*
Student's Gender*

MaleFemale
Student's Grade*

9th10th11th12th
Student's School*

Katella HighschoolSonora HighschoolBuena Park HighschoolFullerton HighschoolSunny Hills HighschoolManuel Arts HighschoolLa Mirada HighschoolOther
If other, specify which school*
Student's Availability

MondaysTuesdaysWednesdaysThursdaysFridaysSaturdaysSundays
Student's Time Frame of Availability

MorningAfternoonEvening
Legal Guardian's Full Name*

First NameLast Name
Legal Guardian's Phone Number
Legal Guardian's E-mail*
example@example.com
Relation to Student*
Questions, Comments, Concerns:
Should be Empty:

Jesus Clubs Discipleship