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Practice & Play Application
We are excited to offer sessions of guided academic support embedded into guided play.
Child Full Name *
Date of Birth *
MM
/
DD
/
YYYY
Grade Level *
Student's Home School *
Does your student have any special needs we should know about? (IEP, severe allergies, etc.)
Feel free to briefly describe your child's interests
Parent(s) Full Name(s) *
Parent Email *
Parent Phone Number(s) *
Address *
Emergency Contact Name & Number *
Do you have a preference of section enrollment? (if flexible, select all that apply) *
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