Dallas Wings vs Portland Fire Game
Tuesday, August 25 - Depart at 4:30pm
Student Name
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First Name
Last Name
Student Date of Birth
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Month
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Day
Year
Date
Student Phone Number
Student's Home Address, City and Zip Code
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Address and zip code are required for participation.
Student's School
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Student's Grade
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Student's Race (Check all that apply)
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Black/African American
Hispanic/Latino
Native American/American Indian
Asian/Pacific Islander
White/Caucasian
Other
Parent/Guardian Name
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First Name
Last Name
Parent/Guardian Email
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example@example.com
Parent/Guardian Phone
*
2nd Parent/Guardian Phone (if applicable)
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DHNS Youth Program Participation Waiver.
Signature - Please sign below.
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