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Registration Form

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Sign Up Your Child for Global Change Agent Academy

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Registration and participation in the Academy is free

Student First Name

Student Date of Birth

Pick Student gender

Address

First Parent Full Name

First Parent Phone

First Parent Email

Student Last Name

Any other information you want to share?

Country of Residence

Second Parent Full Name

Second Parent Phone

Second Parent Email

Parent Signature

I agree to the Memorandum of UnderstandingView the short MoU to continue. This is a MUST READ. Don't just click I agree!

Thanks for submitting! Check your email Inbox or Spam/Junk Folders to complete your registration

Contact Us:

Telephone:

E-mail:

Address:

+1 (713) 927 7179

info@youandyourchild.org

Celina, Texas USA

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