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REGISTRATION FORM
Register your
student or child
Flyer
here.
*
Indicates required field
1st Child's Name
*
First
Last
[object Object]
Select One
*
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
1st Child's School
*
1st child's School District
*
1st Parent's Name
*
First
Last
[object Object]
1st parent's Email
*
1st parent's Phone Number
*
Parent or guardian has reviewed the release form .Choose Any
*
Yes
2nd Child's Name
*
First
Last
Grade
*
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
2nd Child's School
*
2nd child's Child's School District
*
2nd Parent's Name
*
First
Last
Email
*
2nd parent's Phone Number
*
Parent or guardian has reviewed the release form .Choose Any
*
Yes
3rd Child's Name
*
First
Last
Select One
*
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12 Grade
3rd Child's School
*
3rd Child's School District
*
3rd Parent's Name
*
First
Last
3rd parent's Email
*
3rd parent's Phone Number
*
Parent or guardian has reviewed the release form .Choose Any
*
Yes
4th Child's Name
*
First
Last
Select One
*
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12rth Grade
4th Child's School
*
4th Child's School District
*
4th Parent's Name
*
First
Last
4th parent's Email
*
4th parent's Phone Number
*
Parent or guardian has reviewed the release form .Choose Any
*
Yes
5th Child's Name
*
First
Last
Select One
*
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12t Grade
5th Child's School
*
5th Child's Child's School District
*
5th Parent's Name
*
First
Last
5th parent's Email
*
5th parent's Phone Number
*
Parent or guardian has reviewed the release form .Choose Any
*
Yes
Additional Comments
*
A special thanks to the following supporters
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Cant wait to see you online
2020 trip to Ubisoft Headquarters, in San Francisco
Home
Response to COVID
Services
Success
About
Staff
Press
Board
PROGRAMS
Get Involved
Springbreak Registration
Donate
Internal