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T.A.G. The Academic Gym Family and Student Information Form

Parent or Guardian's Information

Multi-line address
Preferred contact method

If none, say N/A

If none, say N/A

If none, say N/A

Student's Information

Gender

(or grade level the student will be entering in September if enrolling during the summer)

Medical Information

Please list any allergies we should be aware of. If none, please say n/a.

Please list any chronic conditions we should be aware of. If none, please say n/a.

Please list any special instructions for Emergency Medical Treatment we should be aware of. If none, please say n/a.

Program Goals and Expectations

Additional Information

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