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2. 
3. Therapeutic Recreation Newsletter Sign Up

   Sign up to receive the Burlington Parks and Recreation Therapeutic Recreation seasonal newsletter.

5. Parent or Guardian's First and Last Name*
7. Parent or Guardian's Email Address

   Please type your email address above if you would like to sign up to receive our seasonal newsletter by email.

9. Participant's First and Last Name*
11. To receive the appropriate program brochure, please select the participant's age range:*
    -- Select One --Youth (ages 0-12 years old)Teen / Young Adult (ages 13-25 years old)Adult (ages 25 years and older)
13. If you would like to be added to our mailing list, please type your mailing address below.
15. Address
17. City
18. State
19. Zip Code
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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

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