Student's Name: (required)

Parent's Name: (required)

Address: (required)

City: (required)

State: (required)

zip: (required)

Email: (required)

Phone: (required)

School: (required)

Birthday: (required)

T-Shirt Size: (required)
---Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult Large

IMPORTANT: Each student must sign a Permission Waiver. Please download, fill out, and bring to the Clinic.

I have downloaded the Permission Waiver

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