Independent Learner Registration Form

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Independent Learner Registration Form

Use this form to sign your child up for the summer online programs. You will receive more information about participation. Please complete a separate form for each child who will participate

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* Indicates required question

Email *

Your email

Student First Name *

Your answer

Student Last Name *

Your answer

Grade completed *

Preschool

Kindergarten

First

Second

Third

Fourth

Fifth

Sixth

Seventh

Eighth

Required

My student would like to participate in *

Reading

Math

Both reading and math

Required

Parent/Guardian First Name *

Your answer

Parent/Guardian Last Name *

Your answer

Parent/ Guardian Email *

Your answer

Parent/ Guardian Phone *

Your answer

Questions

Your answer

Submit

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This form was created inside of Bushnell-Prairie City Community Unit School District #170. Report Abuse