EMC2 Kids Academy Enrollment Form              
Enrollment Form
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Email *
Parent(s) Name *
Parent Phone Number *
Address *
Student's name (last name, first name) *
Date of birth *
MM
/
DD
/
YYYY
Is your child taking any medication? *
Emergency contact. Name and Phone # *
Physician's Name/phone # *
Allergies *
Special Accommodations/needs *
Knowledge is Key; Please share with us a little about your Child. likes, dislikes and Personality social, emotional tendencies, goals, Strengths, talents
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