2021-2022 Homeschool Registration Form
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Email *
Name/Relationship of person completing the form *
Phone number *
Address (complete) *
Student Information
All questions in this section are about the student you are registering.
Name *
Date of Birth/Age *
Last grade level completed *
Does student have an IEP or 504 plan?  Please explain. *
Does student have health concerns? Please explain. *
Emergency contact/name *
Emergency contact number *
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