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Pine River-Backus High School Enrollment Form
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* Indicates required question
Email
*
Your email
Student Full Name (First, Middle, Last)
*
Your answer
Gender
*
Male
Female
Date of Birth
*
MM
/
DD
/
YYYY
Grade
*
Your answer
Primary Parent/Guardian
*
Your answer
Relationship to student
*
Your answer
Primary Parent/Guardian Address
*
Your answer
Primary Parent/Guardian Phone
*
Your answer
Primary Parent/Guardian Cell Phone
*
Your answer
Primary Parent/Guardian (work phone)
Your answer
Secondary Parent/Guardian (if applicable)
Your answer
Relationship to student
Your answer
Secondary Parent/Guardian Address
Your answer
Secondary Parent/Guardian cell phone
Your answer
Secondary Parent/Guardian work phone
Your answer
Does this student have an IEP?
*
Yes
No
Are there any custodial issues involving this student?
*
Your answer
Name of school attended previously
*
Your answer
Emergency Contacts (other than listed above)
Your answer
Emergency Contact phone
Your answer
Relationship to student
Your answer
Emergency Contact #2
Your answer
Emergency Contact #2 phone
Your answer
Relationship to student
Your answer
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