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Student Information

Student Name: Address: City: State: Zip Code: Phone Number: Email: Date of Birth: Current Age: Sex: Male Female School Attending: Grade Next Sept: Mother's Name: Father's Name: Level: Green Red White Blue Shirt Size: Past SCJTL program: Yes No Site Location Mt. Sinai Port Jefferson Northport Hauppauge Shoreham-Wading River Riverhead East Islip Summer Tennis Academy