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Cteen Kickoff 2023

Full Name of teen:*
First Name Last Name
Has teen attended Cteen in the past?

YesNo
Does teen have a cellphone?*

YesNo
Teen's E-mail*
Teen's cell*

Area Code Phone Number
School for 2023-24*
Grade for 2023-24*

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Parent/Guardian*
Prefix First Name Last Name
Parent/Guardian E-mail*
Parent/Guardian Phone Number*

Area Code Phone Number
Comments
Should be Empty:

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