FOCUS Student Engagement Program Enrollment Form
A form must be completed for each student.
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Email *
Student Full Name *
Student Grade *
Student Date of Birth *
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Student School District & Building *
Has student been issued a laptop or tablet? *
Will student be Full-Time or Part-Time? *
Please indicate what days student will be attending FOCUS SEP. *
Required
Please indicate the approximately pickup and drop off time for your student(s). *
Please indicate your desired start date. *
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Please list any special accommodations or allergies we should be aware of. If none, type n/a. *
Please list the names and phone numbers of relatives or designated individuals who may drop off/pick up your child. *
How do you desire to be billed for payment? (Discounts apply for monthly prepay and multi-student, whichever is lowest). *
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