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Child First Name: *
Child First Last Name: *
Grade in Fall 2020: *
Parent/Guardian 1 Full Name: *
Parent/Guardian 1 Phone Number: *
Parent/Guardian 1 Email: *
Parent/Guardian 1 Address: *
Parent/Guardian 2 Full Name:
Parent/Guardian 2 Phone Number (xxx) xxx-xxxx:
Emergency Contact 1 Name
Emergency Contact 1 Phone Number (xxx) xxx-xxxx:
Emergency Contact 2 Name and Phone Number:
Preferred Language at home: *
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