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Virtual STEAM Program Enrollment Form
**Please complete a form for EACH student enrolling**
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* Indicates required question
Student Name
*
Your answer
Grade for 2019-2020 School Year (Current Grade)
*
KDG
T1
1st
2nd
3rd
4th
5th
6th
7th
8th
Best Virtual Contact Information
*
Email
Facebook
Google Hangout
Zoom
Phone Calls
Required
If email, please provide an email address
Your answer
If phone calls or by Zoom, what is the best time to reach your student (i.e. time of day, every day of the week, or just certain days, etc.)
Your answer
Parent/Guardian Name #1
*
Your answer
Cell Phone Number
*
Your answer
Work Phone Number
Your answer
Parent/Guardian Name #2
Your answer
Cell Phone Number
Your answer
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