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First Name

Last Name

Email

Full Address

I give consent for my child to go on these field trips and paticipate in all the other activities in the program. I understand that the parent is responsible to provide food and transportation for the child and we provide snacks and drinks. You can inform us if your child has any alergies.

Youth Information

First Name

Address

Code

Address

Birthday

Thanks for submitting!

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africancaribbeancentreofca@gmail.com

Thanks to our founders & sponsors

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