Registration Form - Fall 2018
(August - December)
Student's Name (First and Last) *
Your answer
Student's Birth Date (mm/dd/yyyy) *
Your answer
Student's Gender *
Parent or Guardian Name (First and Last) *
Your answer
Email Address (Account info and correspondence will be sent to this email. This email will also be used to access the digital @Home subscription) *
Your answer
Re-enter Email Address *
Your answer
Phone Number *
Your answer
Home Address *
Your answer
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