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One City
Jazz Program
Registration Form
Parent/Guardian Information
Parent/Guardian's First Name
Parent/Guardian Email
Parent/Guardian Last Name
Parent/Guardian Phone Number
Mailing Address
City
State
Postal / Zip code
I give permission for images and recordings of my child to be used for promotional and fund raising purposes for the One City program, both now and in the future.
Your Signature
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Student Information
Student's First Name
Student's Last Name
Student's School
Student's level
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Student's Grade in 2023-24 School Year
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Student's T-Shirt Size
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Emergency Information
Emergency Contact Name(s)
Emergency Contact Number(s)
Please list any medical conditions we should know about your child:
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Thank you for submitting!
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