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Brain Train Registration
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Email
*
Your email
Student first and last name
*
Your answer
Parent name
*
Your answer
Parent phone number
*
Your answer
Does your student have a 504 Plan?
Yes
No
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Does your student have any health conditions or allergies you want the nurse to know about?
Yes
No
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Please share your health concern or allergy or leave empty if not applicable.
Your answer
Please share anything specific you would like for me to know about your student. I can use this information when building our schedule each class. Please email me if you have any specific questions. Thank you!
Your answer
Do you give consent for photos to be taken of your student and shared on Nurse Wendy's /MCS webpage and Mat-Su Central's Newsletter?
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No
Other:
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Student grade
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