MBC Youth 2024-2025
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Student Information
Name
*
Gender
*
Please select all that apply.
Male
Female
Date of Birth
*
Address
*
Email
Phone
*
Phone Type
*
Please select all that apply.
Cell
Home
Current Grade
*
Please select one option.
7
8
9
10
11
12
Select Option
7
8
9
10
11
12
Allergies
T-shirt Size
*
Please select one option.
S
M
L
XL
2XL
Parent/Guardian Information
Parent 1 First Name
*
Parent 1 Last Name
*
Parent 1 Email
Parent 1 Phone
Phone Type
Please select all that apply.
Cell
Home
Address
Parent 2 First Name
Parent 2 Last Name
Parent 2 Email
Parent 2 Phone
Parent 2 Phone Type
Parent 2 Address Same as Above
Please select all that apply.
Same
Parent 2 Address
Submit
Description
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