Personal Data
Last Name *
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First Name *
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Address *
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City / Zip *
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Home School *
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Grade *
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Home Phone *
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Parent/Guardian Cell *
List all cell phone numbers AND names
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Parents/Guardian Work Phone *
Include ext. # and parent/guardian's name
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Student Cell *
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Adult Emergency Contact number AND name other than Parent or Guardian *
grandparents/aunts/uncles/brother/sister
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Meds/Health/Allergies problems or Disabilities *
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E-mail Address *
Parent/Guardian and Student
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