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*
Last name
*
Email
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Phone
*
Birthday
*
Month
Day
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Address
*
Preferred Roles
Teacher
Planner
Material Preparation
Class Support
Supplies Coordinator
Donations Specialist
Availability - Please check all that apply
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Days Available
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Monday
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Do you have experience working with children?
Yes
No
Will you consent to a background check?
Yes
No
Please list one professional and one personal reference
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