Student For A Day
Email address *
Student Name *
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Grade *
Parent Name *
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Phone Number *
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Address *
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City *
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Zip *
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Town of Elementary School *
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Elementary School *
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Special Request for Hostess Name *
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Emergency Contact *
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Emergency Contact Phone Number *
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What are you looking for in a High School? (i.e. Sports Program, Science, Clubs, Academics, etc) *
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Select a Date *
Select Class Schedule *
A copy of your responses will be emailed to the address you provided.
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