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Student's Name*
First Last
Program*
Student's Age in June 2023*
Please enter a number from 11 to 19.
Student's Phone
Student's Email*
Student's Gender*
T-shirt Size
Parent's Name*
First Last
Parent's Cell Phone*
Parent's Email*
Name of School Student Attends*
Coach's Name*
Coach's Email*
Skill Level*
How many year's experience does the student have?*
Please enter a number from 0 to 8.
Partner Request (optional)
Roommate Request (optional)
Lab Leader Request (optional)
Any other information we should know?

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