Student Registration 2020-2021
Student Last Name *
Student First Name *
Student Date of Birth *
MM
/
DD
/
YYYY
Class Applied for *
Social Security Number (Optional)
Gender *
Home Address *
Home Phone Number
Cell Phone Number *
Parent/Guardian (1) Name *
Parent/Guardian Phone Number *
Parent Work Number
Parent Email Address *
Parent/Guardian ( 2) Name
Parent/Guardian (2) Email Address
Parent/Guardian(2) Phone Number
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