Truly Valued Program Application

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We will not, in any circumstances, share your personal information with other individuals or organizations without your permission, including public organizations, corporations or individuals, except when applicable by law.
 
 
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Contact Information

 
 
 
 
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Demographic Information

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Parent / Guardian Contact Information

 
 
 
 
Member Information

The following information is necessary for our records and the funding our organization receives. The answers you provide are completely confidential. Your cooperation in providing this information is both appreciated and necessary.
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Health & Emergency Information

 
 
 
 
 
 
 
 
 
Consents & Acknowledgments

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I approve my child joining Truly Valued, Inc. and agree not to Truly Valued, Inc., its Board of Directors, Staff or Volunteers responsible and/or liable, and hereby RELEASE INDEMNITY AND HOLD THEM HARMLESS from liability for losses of any personal property and for injuries or by accidents suffered by my child at a Truly Valued, Inc. or in connection with membership, travel or participation, including any injury or loss caused by or claimed to be caused by the negligence, whether in whole or in part.

I understand that my child shall attend Truly Valued, Inc. an average of (1) day a week.

I ATTEST that the information provided is true and accurate.

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Description

Please fill out this form and click submit.

We will not, in any circumstances, share your personal information with other individuals or organizations without your permission, including public organizations, corporations or individuals, except when applicable by law.