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2. Parent Name (First and Last)*
3. Student Name (First and Last)*
5. EDC Site*
   -- Select One --East EDCBright Beginnings EDC
6. Refund Type*
   -- Select One --Registration FeeTuition FeeSummer Camp FeeLunch FeesOther
8. Refund Remit To Address*
   Please include Street Address, Apartment # (if applicable), City, State and Zipcode)
10. Refund amount**
    *Refund amount is subject to City confirmation
12. Check copy or receipt upload
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14. 1. Receive an email copy of this form.
15. Email address

    This field is not part of the form submission.

16. Submit

* indicates a required field