LEAP Card Application

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Please fill out a LEAP Card application for each HPTS student.

This application process can also be completed in person at the Portage Lake District Library.

Information collected with this form will only be used to create a LEAP card on behalf of the student. This information will not be used for any other purpose within the library or shared with an outside source.

Part 1: Student Information

Last Name *

First Name *

Date of Birth

YYYY

Grade Level *

School ID Number *

Phone Number

Primary Street Address

Postal Code

City or Township

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