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Greek Student Association
Registration Form
Student Information
Student First Name:
Student Last Name:
Address:
Birth Date: (M-D-Y)
Shirt Size
Student Email
Student Phone Number
Other: Are there any allergies or other medical condition(s) that we should be aware of ?
Parent/Guardian Information
Parent 1 First Name:
Parent 1 Last Name:
Address:
Email
Phone Number
Parent 2 First Name:
Parent 2 Last Name:
Adddress:
Contact Email
Contact Phone Number
Emergency Contact
First Name:
Last Name:
Relationship
Contact Phone Number
Student Information:
Student Number:
Student ID will be mandatory when class starts for verification purposes.
Select Your School
Choose an option
Your Signature
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I acknowledge that I have read the consent and waiver terms as well as the conditions and Policy procedures.
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I give permission for my/my child’s photograph (s) and/or video recording(s) to be submitted in newspapers, social media and promotional literature.
Please send me info on the PanMessinian Basketball Program.
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Thanks for submitting!
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