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BEADLE 17-18 JUMP START REGISTRATION - Friday, August 4, 2017
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Beadle Jump Start is for incoming 6th grade students who will be attending Beadle Middle School in the fall.
SEATING IS LIMITED. PLEASE ENROLL YOUR CHILD BY FRIDAY, JULY 21, 2017 IN ORDER TO GUARANTEE YOUR CHILD A PLACE IN JUMP START.
STUDENT INFORMATION
Student's First Name:
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Student's Last Name:
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Student's Address:
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City:
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State:
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Zip Code:
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Home Phone #:
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Student's Gender:
Student's Date of Birth:
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Current Elementary School:
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PARENT CONTACT INFORMATION
Parent #1 Name:
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Parent #1 Phone Number:
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Parent #2 Name:
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Parent #2 Phone Number:
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The name of any other person allowed to pick up your student:
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Phone # of above person:
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JUMP START - FRIDAY, AUGUST 4, 2017
PLEASE PICK YOUR PERFERRED SESSION BELOW
BMS Jump Start Time Preference (Select One)
HEALTH INFORMATION:
Please list/describe any health concerns (vision, hearing, diabetes, asthma, allergies, restrictions, etc.) which we should know about for the BMS Jump Start events:
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SIGNATURE(S):
BEADLE MIDDLE SCHOOL JUMP START WILL BE A FUN FILLED AND CHALLENGING LEARNING EXPERIENCE FOR STUDENTS.

THE SAME BEHAVIORS EXPECTED DURING THE REGULAR SCHOOL YEAR WILL BE ENFORCED DURING JUMP START.

Parent's Signature (a parent's name in this box acknowledges you and your student have read the above statement):
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PAYMENT INFORMATION:
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