HCCYG SERVICE DAY
with Cass Community Social Services in Detroit
Participant Name
First Name
Last Name
Participant Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
2026-2027 Grade
Food allergies or dietary accommodations needed
Medical needs or severe allergies
Emergency Contact Name for January 18th
First Name
Last Name
Emergency Contact phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
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