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Jesse Kolber College Application Crash Course Registration Form/ Formulario de Inscripción
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* Indicates required question
Student First and Last Name / Nombre del estudiante
*
Your answer
School Name / Nombre de la escuela
*
Your answer
Birth Date / Fecha de nacimiento
*
MM
/
DD
/
YYYY
Age / Edad
*
Your answer
Gender / Sexo
*
Male / Hombre
Female / Mujer
Non - Binary
Not Listed / No enlistado
Prefer Not To Say / Prefiero no decirlo
Other:
Ethnicity :
*
Your answer
First Language spoken at home
*
Your answer
Second Language spoken at home
Your answer
Address / Dirección
*
Your answer
Student Cell / Número de celular del estudiante
*
Your answer
Student Email / Correo electrónico del estudiante
*
Your answer
Parent/Guardian Name / Nombre del padre/Guardián
*
Your answer
Parent/Guardian Home Phone Number / Teléfono de la casa del padre/Guardián
Your answer
Parent/Guardian Cell Phone / Teléfono celular del padre / tutor
*
Your answer
Parent Email / Correo electrónico del los padres
Your answer
Emergency Contact Name / Nombre de contacto de emergencia
*
Your answer
Emergency Contact Phone Number / Teléfono de contacto de emergencia
*
Your answer
Relationship / Relación con contacto de emergencia
*
Your answer
Do you qualify for free or reduced lunch? / ¿Calificas para almuerzo gratis o reducido?
*
Yes / Si
No
Allergies or Medical Conditions? / ¿Alergias o condiciones médicas?
*
Yes /Si
No
If yes to the question above, please explain / Si la respuesta es sí, por favor explique
Your answer
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