Student and Parent Contact Information Collection
Please fill out the form below to provide contact information for both the student and their parent/guardian.
Student
Student Name
*
Grade
*
Student's Phone Number
Please enter a valid phone number.
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Parent/Guardian 1
Parent/Guardian 1 Full Name
*
First Name
Last Name
Parent/Guardian 1 Email Address
*
example@example.com
Parent/Guardian 1 Phone Number
*
Please enter a valid phone number.
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Parent/Guardian 2
Parent/Guardian 2 Full Name
First Name
Last Name
Parent/Guardian 2 Email Address
example@example.com
Parent/Guardian 2 Phone Number
Please enter a valid phone number.
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Next
Additional Notes or Comments
Payment will be collected in person. Cash or checks accepted.
Club Venom Waiver
Waiver
*
I have read and agree to the terms in the Club Venom Waiver.
Submit
Should be Empty: