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College Preview Days Pre-Registration

Required fields are marked *

BIO INFORMATION    

First Name:*

 

Last Name:*

 

Gender:*

 

M: F:

Age:*  

Graduation Year:*

 

Phone:*

 

Email:

 

MAILING ADDRESS    

Street:*

 

City:*

 

State:*

 

Zip Code:*  
PROGRAM INFO    
I will be attending (Choose a date):*  

 

 

 

MUST BE COMPLETED BY STUDENT'S PARENT/GUARDIAN

I am coming

 PARENTAL CONSENT must be completed for every participant under age 18.

I give permission for my child to participate in the College preview days on the campus of Vennard College. In case of emergency I give my permission to Vennard College to seek medical treatment for the participant named above.

   

Parent's Signature:*

 

Signature Date:*

 

Health Insurance Provider:*  
Insur. Policy Number:*  
Emergency Phone:*  
Emerg. Contact Person:*  

Health Issues/Comments:

 

Please, list major health concerns, allergies, etc.

  

     

 

Thank you for letting us know you're coming!

 

   

   

 
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