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Member Information
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"Full" First Name:
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Middle Name:
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Last Name:
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Nick Name:
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Gender:
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School:
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Age:
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Date of Birth:
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mm/dd/yyyy
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T-shirt Size:
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Information
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Food Allergies? If yes, please list:
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Youth Email Address:
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Home Address:
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City:
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State:
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Zip Code:
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Any health concerns?:
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Hobbies & Talents: clubs, sports, games, musical abilities, etc.?:
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How will you typically be getting to Pathfinders?:
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How will you typically be getting home?:
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Parent/Guardian Information
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Parent/Guardian #1:
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Cell Phone:
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Secondary Phone:
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Home Phone
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Email Address:
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Please use this email address for weekly communication:
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Yes, I am able to support the program in the following way:
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(driving on field trips, signing up and providing dinner or snack items, working on special events, contributing a monetary donation in the amount of $)
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Parent/Guardian #2:
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Cell Phone:
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Secondary Phone:
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Email Address:
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Please use this email address for weekly communication:
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Emergency Contact Information
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Name:
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Cell Phone:
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Secondary Phone:
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Relationship to Youth:
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