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Join our Olympic Dreams Clinic Q&A with an NIL expert, Stanford & SJSU coaches, and elite athletes on 9/22 from 1:30-2:30 pm. Learn about NIL, branding, and the future of college athletics. Cost is $25 per parent. Don't miss out!
Event:
Start Date/Time:
End Date/Time:
Fee per Family:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
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Type
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Father
Grandparent
Guardian
Mother
Parent
Self
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Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
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City:
*
State:
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AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
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NY
NV
OH
OK
OR
PA
RI
SC
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TN
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WA
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Zip:
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Emergency Contact Info (Other than Parents)
*
Add New Student #1:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Prefer not to state
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (N/A if NONE):
*
Allergies (N/A if NONE):
*
Medications (N/A if NONE):
Primary Doctor:
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Prefer not to state
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (N/A if NONE):
*
Allergies (N/A if NONE):
*
Medications (N/A if NONE):
Primary Doctor:
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Prefer not to state
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (N/A if NONE):
*
Allergies (N/A if NONE):
*
Medications (N/A if NONE):
Primary Doctor:
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Prefer not to state
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (N/A if NONE):
*
Allergies (N/A if NONE):
*
Medications (N/A if NONE):
Primary Doctor:
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Prefer not to state
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (N/A if NONE):
*
Allergies (N/A if NONE):
*
Medications (N/A if NONE):
Primary Doctor:
Questions/Options:
Name of parent attending the Q & A.
*
Level of your gymnast.
*
Additional Information:
Other Questions/Comments:
Credit Card Verification:
Card Number:
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Visa
Mastercard
Name as it appears on card:
*
Nickname:
Card Expiration Month:
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Exp Year:
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2024
2025
2026
2027
2028
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2030
2031
2032
2033
2034
2035
2036
2037
2038
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2046
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2048
2049
2050
2051
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2053
2054
Address Line 1:
Address Line 2:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip:
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