Life Learning Academy
Student Registration Form
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Email *
Today's Date *
MM
/
DD
/
YYYY
Parent Name *
Student Full Name *
Student DOB *
Home Address *
City, State and Zip *
Phone Number - -  Text Y/N? *
Current grade level (for the school year you are registering for) *
School Year *
What types of supports would you like to receive from the staff of Life Learning Academy? *
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