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Name: *

Grade Entering *

Parent(s) Name(s): *

Home Phone: *

Email: *

Address 1: *

Address 2:

City: *

Zip: *

Date of Birth: *

School: *

Please list the school activities in which you are involved: *

Please list all honors and awards you have received: *

Other interests/hobbies: *

Briefly explain why you would like to be a part of the U-TURN Summer Sports Leadership Academy: *

Security Code: *

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