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MPS & MES Reaching Every Child (REC) Application
21st Century After-School Program
September 28, 2020 - May 20, 2021
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* Indicates required question
Child's Name:
*
Your answer
Gender
*
Male
Female
Grade
*
2nd
3rd
4th
5th
6th
Child's Teacher:
*
Your answer
Child's Age:
*
Your answer
Days of the week your child is on campus:
*
Your answer
Parents' Names:
*
Your answer
Address:
*
Your answer
Best Phone Number:
*
Your answer
Mother's Day Phone:
*
Your answer
Mother's Cell:
*
Your answer
Father's Day Phone:
*
Your answer
Father's Cell:
*
Your answer
Directions to Home:
*
Your answer
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