Entry Form and Parental Release
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Student Name: _________________
Fax or mail this form to:
Address: _________________
Fax:
(703) 885-3493
_________________
Address:
13625-A Dulles Technology Dr.
_________________ Herndon, VA 20171
_________________
Telephone #: _________________
Date of Birth: _________________
Every Human Has Rights Student Entry
My entry is about this Human Right: ______________________
Parent/Legal Guardian’s Signature: _______________________________