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2021-22 New Student JCCA Enrollment Survey
Student Name *
Gender *
Birthday *
MM
/
DD
/
YYYY
Grade Level *
What school did your student previously attend? *
Parent(s)/Guardian(s) Name(s) *
Parent(S)/Guardian(s) Phone Number *
Parent(s)/Guardian(s) Email Address *
Preferred mode of contact *
What is the best time to contact you? *
Home Address *
Will your child primarily be a bus rider or a car rider? *
Would you be interested in before and/or after school care? *
Does your student have an IEP? *
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