Charms Office Information Form
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Student First Name *
Student Last Name *
What high school are you zoned for? *
Student Grade *
Student ID # *
Student Address *
Student ZIP *
Student DOB *
MM
/
DD
/
YYYY
Student Email Address *
Student Personal E-mail Address
Student Cell Phone
Student Class Period *
Student Instrument *
Student T-Shirt Size *
Adult 1 first name *
Adult 1 last name *
Adult 1 Address if different
Adult 1 ZIP if different
Adult 1 DOB
MM
/
DD
/
YYYY
Adult 1 cell phone *
Adult 1 email address *
Adult 2 first
Adult 2 last name
Adult 2 Address if different
Adult 2 ZIP if different
Adult 2 DOB
MM
/
DD
/
YYYY
Adult 2 cell phone
Adult 2 email address
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