By submitting this form, I certify that all information is true and correct to the best of my knowledge. Note: Pacific Heritage Academy is requesting this information to better serve the needs of our students under the authority of PL 94-192, Title IV of the Civil Rights Law and State Administrative Rule R227-716 (1 to 5). This information will be handled confidentially and will be used only for the purposes noted in the law or rule. This information will not subject you to unfair or discriminatory treatment.
Your name (I certify that I am the custodial parent and/or legal guardian):
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