Charms Registry Information
Student ID *
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Student First Name *
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Student Middle Name
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Student Last Name *
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Grade *
Birth Month *
Birth Day *
Birth Year (XXXX) *
Gender *
Primary Instrument *
Secondary Instrument
Street Address *
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City *
State *
Zip Code *
Home Phone *
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Student Cell Phone *
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Student Email *
Your answer
Primary Parent/Guardian First Name: *
Your answer
Primary Parent/Guardian Last Name: *
Your answer
Primary Parent/Guardian Email *
Your answer
Primary Parent/Guardian Cell Phone
Your answer
Secondary Parent/Guardian First Name: *
Your answer
Secondary Parent/Guardian Last Name: *
Your answer
Secondary Parent/Guardian Email
Your answer
Secondary Parent/Guardian Cell Phone
Your answer
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