REGISTRATION FORM
Location
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Student's Legal First Name
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Student's Legal Last Name
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Student's Preferred Name
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Student Date of Birth
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School
Grade
Home Address
Parent's Legal First Name
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Parent's Legal Last Name
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Parent's Preferred Name
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Parent's Phone
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Parent's Email Address
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Place of Employment
Work Number
Second Parent's Legal First Name
Second Parent's Legal Last Name
Second Parent's Preferred Name
Second Parent's Phone
Second Parent's Email
Emergency Contact 1 Name
Emergency Contact 1 Cell
Relationship to Child
Emergency Contact 2 Name
Emergency Contact 2 Cell
Relationship to Child
Emergency Contact 3 Name
Emergency Contact 3 Cell
Relationship to Child
Asthma
Diabetes
Heart Disease
Hearing Problem
Glasses or contact lenses
Gluten intolerance or special diet
Allergies
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Health issues
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Special Needs
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Parent/Guardian Name (print)
Date
Today's date
Signature
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