Disclosure Signature Math 2 4th Period

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Student's Last Name *

Student's First Name *

Guardian's Name *

Guradian's Contact Phone Number *

Guardian's Contact Email Address *

Father's Name

Father's Contact Phone Number

Mother's Name

Mother's Contact Phone Number

STUDENT Signature *

By checking this box, I acknowledge and agree to the policies and procedures stated in the disclosure document.

I acknowledge and agree.

Required

PARENT Signature *

By checking this box, I acknowledge and agree to the policies and procedures stated in the disclosure document.

I acknowledge and agree.

Required

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