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Summer Enrollment 2020
Student Information Registration for Summer Enrichment
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* Indicates required question
Email
*
Your email
Phone Number
*
Your answer
Student Name
*
Your answer
Birth Date
*
MM
/
DD
/
YYYY
Entering Grade
*
Choose
kindergarten
first grade
second grade
third grade
fourth grade
fifth grade
sixth grade
seventh grade
prekindergarten 3/4
Address (street, city, zip code)
*
Your answer
Parent / Guardian Name
*
Your answer
Allergies
*
food
medication
seasonal
None
Other:
Educational Challenges
*
Your answer
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