Dungeons & Dragons Teen Group, Athol Public Library
Parent's Name
*
First Name
Last Name
Have you registered your child for D&D Teen Group in the past?
*
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(Parent's) Date of Birth
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Address
*
Street Address
Street Address Line 2
City
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Parent's Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Teen #1 Name
*
First Name
Last Name
Date of Birth
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1920
Year
Address (if different than parent's address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you need to register another teen?
*
Yes
No
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Teen #2
*
First Name
Last Name
Date of Birth
*
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1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Address (if different than parent's address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you need to register another teen?
*
Yes
No
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Teen #3
*
First Name
Last Name
Date of Birth
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
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20
21
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25
26
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28
29
30
31
Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
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2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
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1962
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1952
1951
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1932
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1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Address (if different than parent's address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Teen #1
*
First Name
Last Name
Teen #2
First Name
Last Name
Teen #3
First Name
Last Name
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I give permission for the above children to attend Dungeons & Dragons Teen Group run by Valuing Our Children's North Quabbin Family Resource Center (FRC) located at the Athol Public Library. Please signature below
*
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