Summer 2010
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I am registering my child for the following summer program:
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| Student Name ___________________________________ | Age ______________ |
| Phone___________________________________ | Email ______________________________ |
| Address _________________________________________________________________ | |
| Parent/Guardian Name_____________________________________________________ | |
|
413 863 2281; email shea@valinet.com |
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Payment option:
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| Include the information above with your payment. |