New Student Registration

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New Student Registration

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Student Information

Name:

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Date: *

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Home Phone and Cell Phone #: *

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Address: *

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City, State and Zip Code: *

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Email Address: *

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Gender: *

Male

Female

Date of Birth: *

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DD

/

YYYY

Age: *

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Place of Birth:

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Grade Level Entering: *

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Date of SDA Baptism:

MM

/

DD

/

YYYY

Church Membership: *

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