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After School Program Registration
STUDENT INFORMATION
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Student's LAST Name *
Student's FIRST Name *
Student's Full Home Address *
Student's Date of Birth *
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Student's Current Age *
Student's School Identification Number (if you know)
Student's School for the 2026.27 School Year *
Student's Gender *
Number of Siblings You Are Enrolling in After School Programming  *
Student's Nationality *
Student's Shirt Size *
Student Currently Uses Medication, Food Supplement or Medical Food? *
Student receives... *
Student is Limited English Proficient (LEP) *
Student has an IEP *
Student has a 504 Plan *
Student has been identified Gifted/Talented *
My Student is Interested in... *
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