Hip Hop January 2021
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Studentʻs Information
Frist Name *
Last Name *
Grade *
Room #
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Pick Up *
Parentʻs Information
Motherʻs Name *
Motherʻs Phone *
Motherʻs Email *
Fatherʻs Name *
Fatherʻs Phone *
Fatherʻs Email *
Emergency Contact Information
In case of an emergency and parents cannot be reached please include an emergency contact.
Name *
Relation to student *
Phone Number *
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