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OPES Student Health Card 2020-2021
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* Indicates required question
Email
*
Your email
Student's Name last name, first name, middle name
*
Your answer
Gender
*
Female
Male
Prefer not to say
Other:
Street Address
*
Your answer
City
*
Your answer
Zipcode
*
Your answer
County
*
Lexington County
Richland County
Other:
Grade in 2020-2021
*
Choose
4K
Kindergarten
1st
2nd
3rd
4th
5th
Birth date
*
Example: 01/01/2020
Your answer
Age
*
Your answer
End of day dismissal:
*
Check all that apply
Bus
Car
Walker
Daycare
Other:
Required
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