Kindergarten- 3rd Grade                                      Virtual Summer Program Application
Bessemer City Schools
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Student's First Name *
Student's Last Name *
STUDENT'S ADDRESS
Street *
City *
Zip Code *
Primary Phone Number *
Secondary Phone Number *
Parent's/Legal Guardian's Name *
Parent's Email *
Emergency Contact Name *
Other than parent/guardian entered above.
Emergency Contact Number *
Other than parent/guardian entered above.
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