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Parent/Guardian Information

First Name *
Last Name *
Address *
City *
State *
Zip *
Email *
Telephone *
Secondary Adult First Name
Secondary Adult Last Name
12th Man Donor Number
Ship Materials Ship items to me
Pick up JAC items
How Did You Hear About Us? Returning Members
Friend
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The Eagle
Other:

Child Information

First Name *
Last Name *
Email  
Date of Birth *
Gender
Grade *
School *
T-Shirt Size *

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