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Last Page

Primary Contact Information

Primary Contact First Name *
Primary Contact Last Name *
Address Line 1 *
Address Line 2
City *
State *
Zip Code *
Primary Contact Phone Number *
Primary Contact e-Mail *
Your Relationship to the Student? *
Other Relationship
Primary Contact willing to be contacted to volunteer for YETI activities?

Secondary Contact Information

Secondary Contact First Name *
Secondary Contact Last Name *
Secondary Contact Phone Number *
In the event that an injury should occur that requires immediate medical attention, I understand that the staff of Bluff City Theater will call 911. I assume the responsibility for payment of any such treatment, or costs incurred from such a call. *

02. Student Information

Number of Students

First Student

First Student First Name *
First Student Last Name *
First Student Gender *
First Student Grade *
First Student Phone *
First Student e-Mail *
First Student Session *
First Session Amount
$
First Student Allergies *
First Student Known Allergies *

Second Student

Second Student First Name
Second Student Last Name
Second Student Gender
Second Student Grade
Second Student Phone *
Second Student e-Mail
Second Student Session
Second Student Session Amount
$
Second Student Allergies
Second Student Known Allergies

Third Student

Third Student First Name
Third Student Last Name
Third Student Gender
Third Student Grade
Third Student Phone *
Third Student e-Mail
Third Student Session
Third Student Session Amount
$
Third Student Allergies
Third Student Known Allergies

03. Additional Information

Total for all Student Sessions
$
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