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My Chesterfield Academy Application

  1. * Indicates required fields

  2. Are you employed?*

  3. Is your employer aware that you would like to participate in My Chesterfield Academy?

  4. Do you have other family members who are applying for this session of My Chesterfield Academy?*

  5. Commitment Contract*

    You must agree to all of the following terms to be considered for participation.

  6. Acknowledgement*

    I acknowledge that video and still photos will be taken during the academy and may be used in county promotions.

  7. Leave This Blank:

  8. This field is not part of the form submission.