Varnum Brook ES Pre-Registration Form
Email address *
Name of Parent/Guardian Completing this form *
Relationship to Student *
Contact Phone Number *
Physical Address - Street *
Physical Address - City/Town *
Approximate date your student will be starting *
MM
/
DD
/
YYYY
Grade Entering *
Student First Name *
Student Middle Name *
Student Last Name *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
City/State of Birth *
First (Native) Language *
Mailing Address - Street *
Mailing Address - City/Town *
Ethnicity
Clear selection
Race
A copy of your responses will be emailed to the address you provided.
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