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CULTURAL
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Homework Center Registration
CO-FOUNDERS
Crystal Jackson, MA
Karesa Jacobs, MBA
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The Homework Center
Child's First name
*
Child's Last name
*
Child's Birthday
*
Month
Month
Day
Year
Gender
*
Hobbies
*
Areas of Difficulty
*
Parent(s) Name
*
Phone
*
Child's Authorized Pick Up Person
*
Emergency Contact & Number
*
Allergies
*
Register
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