Student Information
Student Last Name
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Student First Name
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Date of Birth
MM
/
DD
/
YYYY
Grade for 2017-2018 School Year
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Home Address
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Mailing Address (if different)
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Home Phone
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What school did the student attend last year
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Does you child have a valid tribal membership
Does your child take a daily medication that will need to be kept at the school?
Mother's Name
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Mother's Address (if different)
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Mother's Cell Phone
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Mother's Work Phone
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Mother's E-Mail Address
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Do you want to communicate via e-mail
Father's Name
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Father's Address (if different)
Your answer
Father's Cell Phone
Your answer
Father's Work Phone
Your answer
Father's E-Mail Address
Your answer
Do you want to communicate via e-mail
Emergency Contact #1 Name/relationship/phone number
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Emergency Contact #2 Name/relationship/phone number
Your answer
Emergency Contact #3 Name/relationship/phone number
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Emergency Contact #4 Name/relationship/phone number
Your answer
Emergency Contact #5 Name/relationship/phone number
Your answer
Please list any siblings enrolled in Yale Public Schools (Name/Grade)
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