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2021-2022 Student Emergency Contact Information
Please complete the information below for the 2021-2022 school year. It is essential that we have complete and accurate emergency contact information for each child. Please complete the contact info
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Student: Last Name:
*
Your answer
Student: First Name:
*
Your answer
Date of Birth: (mm/dd/yy)
*
Your answer
Current Grade:
*
Choose
K
1
2
3
4
5
6
7
8
Home Address:
Street:
*
Your answer
City:
*
Your answer
Zip Code:
*
Your answer
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