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  Phone :
(859)360-0500

Fax :
(513)860-4811

Email :
janelle@MyStepHigher.org
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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.  
* Indicates Required Fields
 
* Name  
  Tour
* Email Address  
  Phone Number
  Address
  City
  State
  Zip
  Date of Birth    
  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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