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"Enter a valid Cell Phone Number or Leave Blank"

Organization Name* *
Contact Person* *
Address
City, State, Zipcode
Email
Phone Number* *
Cell Phone Number*
Type of Services
Avarage Age of Participants
Do you Offer
After School Summer Camp Both
Would Parents be able to Signup for your Service at Schools out
Yes No

For more information, please contact the office of Councilmember Desley Brooks
(510) 238-7006 dbrooks@oaklandnet.com
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