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Student and Parent Information
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* Indicates required question
Child's Last Name
*
Your answer
Child's First Name (Preferred Name)
Your answer
Child Birthday
MM
/
DD
/
YYYY
Parent/Guardian One Name
*
Your answer
Parent/Guardian One Phone
*
Your answer
Parent/Guardian One Email
*
Your answer
Parent/Guardian Two Name
Your answer
Parent/Guardian Two Phone
Your answer
Parent/Guardian Two Email
Your answer
Parent/Guardian Two Employer/Occupation
Your answer
Best Name and Phone Number for Immediate Contact
*
Your answer
Who does your child live with?
*
Mother and Father
Mother
Father
Grandparent
Aunt/Uncle
Other:
Student Allergies/Medical Information
Your answer
Student T-Shirt Size
*
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
Is there any information your student's teacher should know in order for them to be successful this year?
Your answer
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