Southport Christian School
APPLICATION FORM
Email address *
STUDENT INFORMATION
Last Name *
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First Name *
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Middle Name
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Date of Birth *
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Age *
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Grade Entering *
Address *
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City *
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State *
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Zip Code *
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Has your student ever been expelled, suspended, or been involved in frequent disciplinary action? *
If yes, please explain:
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PARENT INFORMATION:
Father's Last Name
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Father's First Name
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Father's Address
Father's Cell Phone Number
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Father's E-mail Address
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Mother's Last Name
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Mother's First Name
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Mother's Address
Mother's Cell Phone Number
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Mother's E-mail Address
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