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Parent Name*
Username*
Password*
Address*
City*
State*
<State>
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip*
Email*
Primary Channel to receive important notifications
Cell/Opt-In #*
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By checking this box, I agree to receive recurring auto dialed phone calls or text messages from or on behalf of ACTIVSTARS the telephone number provided, including messages that are based on my phone’s location. I understand that consent is not a condition of any purchase. Messages and data rates may apply. Would you like to receive calls/text messages regarding important program alerts such as moves, cancels, promotions, and other important reminders?
Ok to receive SMS Text notifications
Alternate #*
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*required field