Name of School (Please type full school name. If student is homeschooled please write "Homeschool") *
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Please identify any physical disabilities, restrictions, conditions, or illnesses which might require medical attention, impact student participation in classes, or be useful for instructor(s) to bear in mind: *
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Parent/Guardian 1 First Name *
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Parent/Guardian 1 Middle Name
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Parent/Guardian 1 Last Name *
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Parent/Guardian 1 Date of Birth
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Parent/Guardian 1 Gender
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Parent/Guardian 1 Pronouns
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Parent/Guardian 1 Address Street *
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Parent/Guardian 1 Address City *
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Parent/Guardian 1 Address State *
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Parent/Guardian 1 Address Zip Code *
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Parent/Guardian 1 Phone Number (with area code) *
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Parent/Guardian 1 Email Address *
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Parent/Guardian 1 Employer (No acronyms please)
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Parent/Guardian 1 Relationship to Student *
Parent/Guardian 2 First Name
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Parent/Guardian 2 Middle Name
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Parent/Guardian 2 Last Name
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Parent/Guardian 2 Date of Birth
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DD
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YYYY
Parent/Guardian 2 Gender
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Parent/Guardian 2 Pronouns
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Parent/Guardian 2 Address Street
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Parent/Guardian 2 Address City
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Parent/Guardian 2 Address State
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Parent/Guardian 2 Address Zip Code
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Parent/Guardian 2 Phone Number (with area code)
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Parent/Guardian 2 Email Address
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Parent/Guardian 2 Employer (No acronyms please)
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Parent/Guardian 2 Relationship to Student
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