West York Middle School Field Trip to

Washington DC & King's Dominion

May 4-5, 2024

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STUDENT INFORMATION
Student Name*
First Last
Student Home Address
This address will be used to send any refunds in the even that they cannot be electronically processed.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Parent/Guardian 1*
First Last Relationship
Primary Phone*
Secondary Phone
Email*
Used only for trip communications - then deleted.
Enter Email Confirm Email
Parent/Guardian 2
First Last Relationship
Parent/ Guardian 2 Phone
Parent / Guardian 2 Email
Enter Email Confirm Email