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Mosaic2024

2024 WAITLIST – SPARK! Build—Mosaic

August 5-16 (two weeks), Monday-Friday, 9am-3pm Ages: Middle and High School

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Student's Information

Student's Name*
MM slash DD slash YYYY
SNAP Participant?*
Student's Address*

Parent/Guardian's Information

Parent/Guardian's Name*

Emergency Information

Emergency Contact's First Name*

Photography/Media Acknowledgment

BY ACKNOWLEDGING AND TYPING MY NAME BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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