Census Form
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School of attendance *
Grade Level *
Student's Last Name *
Student's First Name *
Birth Date *
MM
/
DD
/
YYYY
Address *
Mailing Address (If different than address)
Contact 1 Name *
Contact 1 Name Home Phone Number *
Contact 1 Name Cell Phone Number *
Contact 1 email *
Contact 1 relationship to student *
Contact 2 Name
Contact 2 Name Home Phone Number
Contact 2 Name Cell Phone Number
Contact 2 email
Contact 2 relationship to student
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