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After School Registration
2021 Spring Semester (March 1 - May 27th)
6th - 8th Grade
Thursdays 4:00 - 5:00pm
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* Indicates required question
Child's Full Name
*
Your answer
Nick Name
Your answer
Date of Birth
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MM
/
DD
/
YYYY
Age & Grade
*
Your answer
Current School Attending
*
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Sex
*
Female
Male
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Other:
Street Address, City, State and Zip
*
Your answer
Mailing Address (If Different)
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Father/Primary Guardian
*
Your answer
Occupation
*
Your answer
Email Address
*
Your answer
Home Phone
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Cell Phone
*
Your answer
Mother/Guardian 2
Your answer
Occupation
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Email Address
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Home Phone
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Cell Phone
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Does your child have any special needs?
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Please list any Chronic medical Conditions & current medications they are taking
*
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Please list Allergies (including Food)
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Please list other children in the family (name and age)
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By clicking the box below I authorize all the above information is correct to the best of my knowledge and I understand that All application list items and parent notes are understood.
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