SMPK Registration 2019-2020
Student Information
Email address *
Name of Person Filling out the Registration
Your answer
Child's First Name *
Your answer
Child Last Name *
Your answer
Name child is called by (if different than first name)
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age as of 9/1/2019 *
Your answer
Gender *
Best Contact Phone Number *
Your answer
Home Street Address *
Your answer
Home City *
Your answer
Zip Code *
Your answer
Child lives with:
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