Ujima Family Literacy Nights
REGISTRATION FORM
Today's Date
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Name of Parent/Guardian 1
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Name of Parent/Guardian 2
Mailing Address
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Email Address(es)
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Contact Number(s)
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Permission for your child/children to be included in promotional photos/videos:
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Yes, my child may be included
No, please do not include my child
Child #1
Full Name
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First Name
Last Name
Birthdate
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Age
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School
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Current Grade Level
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Comments
Child #2
First Name
Last Name
Birthdate
Age
School
Current Grade Level
Comments
Child #3
First Name
Last Name
Birthdate
Age
School
Current Grade Level
Comments
Signature of Parent/Guardian
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Submit
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