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* 1. Youth's full name?

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* 2. Parent/ guardian full name?

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* 3. Parents/ Guardian phone number?

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* 4. What is your reason for wanting to attend "The Hangout"?

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* 5. How did you hear about this group?

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* 6. What school do you attend?

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* 7. What date(s) do you plan to attend?

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