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Students Conquering Anxiety Group
Ages 6-11; Wednesdays from 4-5 pm, October 4-25
Ages 12-16; Thursdays from 7-8 pm, October 5-26
$100 per student
I am registering for:
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$100
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Ages 6-11; Wednesdays from 4-5PM, October 4-25
$100
-
Ages 12-16; Thursdays from 7-8PM, October 5-26
Parent/Guardian Contact Information
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone
*
Parent/Guardian Email
*
Verify Email
*
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Student Information
Student Name
*
First Name
Last Name
Student Date of Birth
*
(mm/dd/yyyy)
Student Current Grade in School
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