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Phone :
(859)360-0500
Fax :
(513)860-4811
Email :
janelle@MyStepHigher.org
Please fill this form out completely. Health insurance is required Student will keep insurance card with them at all times. This form must be completed and retuned to Step Higher for participation on the college tour program.
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Indicates Required Fields
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Name
Tour
Tour A
Tour B
Tour C
Tour D
*
Email Address
Phone Number
Address
City
State
Zip
Date of Birth
January
February
March
April
May
June
July
August
September
October
November
December
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1980
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2007
Age
Name of High School Attending
Grade
Health insurance Co
Parents/Guardians' Name
I agree to the Step Higher Guidelines and agree that my child will abide by them.
I agree that if it is solely necessary that if my Child Disrespect the Step Higher contract, guidelines, or rules, they will be sent home at the Parent’s expense.
Parent's Name Guardian's Name
Bus will Depart - March 2008
Mail To: Step Higher P.O. Box 2306 Covington, Kentucky 41012
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