2021-2022 Current Student Pre-Enrollment
This form is to pre-enroll current Middleberg students for the 2021-2022 School year. Students who are returning in the fall of 2021 must fill out this form.
Student First Name *
Student Last Name *
2021-2022 Grade Level *
Current Student Physical Address *
Current Student Mailing Address (if different from physical address)
Parent/Guardian Name #1 (student lives with) *
Parent/Guardian #1 Phone Number *
Parent/Guardian Name #2 (student lives with)
Parent/Guardian #2 Phone Number
Emergency Contact #1 (Include Name, Phone Number and relationship ) *
Emergency Contact #2 (Name, Phone Number and relationship) *
Does student have any allergies? *
If Yes, please list allergies and explain
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