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Participation Information 2020-2021
* Indicates required question
Email address (not school email)
*
Your answer
Student First and Last Name
*
Your answer
Current Grade Level
*
8th grade
9th grade
10th grade
11th grade
School attended
*
Bettendorf Middle School
Bettendorf High School
Other:
Home address
*
Your answer
Phone number of participant
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Allergies/Health Problems/Medications (Please describe in detail)
Your answer
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