Lighthouse Learning
2019-2020 High School Registration Form
Student first name *
Your answer
Student last name *
Your answer
Student's birthday *
MM
/
DD
/
YYYY
Student's grade *
Parent(s) first and last name(s) *
Your answer
Mailing Address *
Your answer
Mother's phone number
Your answer
Email address
Your answer
Father's phone number
Your answer
Email address
Your answer
Home Address
Your answer
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