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Name of Student REQUIRED Please fill out this field. Please enter valid data.

Parent/Guardian's Name REQUIRED Please fill out this field. Please enter valid data.

Phone Number 1 REQUIRED Please fill out this field. Please enter a phone number.

Phone number belongs to: REQUIRED Mother Father Guardian Please fill out this field.

Grade REQUIRED 7th 8th 9th 10th 12th Please fill out this field.

Church REQUIRED St. James St. Philip Our Lady of Peace Please fill out this field.

NET Youth Retreat