*
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Parent/Guardian First/Last Name
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Parent/Guardian Email Address
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Phone Number
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Child First/Last Name
*
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Child Grade (current)
*
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Child School?*
Glencoe
Forest Park
Odyssey
PJA
Child Date of Birth
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Upon hitting the SUBMIT button, your form will be sent directly to our Director of PJA Afterschool Programs, Carly Landau. Please be sure to hit SUBMIT only one time. Thank you so much for your interest in PJA Afterschool Programs!
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