Name *

First Name

Last Name

Best number to reach you at *

(###)

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Parent Name *

First Name

Last Name

Parent Phone Number *

(###)

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Do you accept your spot in Groundwork's Hartford Stewardship Program? *

Yes

No

Will you be able to attend the program and stewardship dates listed on the email? *

Program participants are expected to attend all program and stewardship dates.

Yes

No