MVCSD OPEN ENROLLMENT
Student's Information
Email *
First Name *
Middle Initial *
Last Name *
Current Grade *
Birth Date *
MM
/
DD
/
YYYY
Home Phone Number *
Work Phone Number
Message Phone Number *
Parent's Name *
Home Address (Street, City, Zip) **P.O. Box is not acceptable as an address** *
Home Address (Street, City, Zip) *
Will you be using Mesa Vista Bus Transportation? *
Please enter 3 Emergency Contacts
1st Emergency Contact Name *
1st Emergency Phone Number *
1st Emergency Contact Relationship *
2nd Emergency Contact Name *
2nd Emergency Phone Number *
2nd Emergency Contact Relationship *
3rd Emergency Contact Name *
3rd Emergency Phone Number *
3rd Emergency Contact Relationship *
Please List any Allergies or Medical Conditions *
The above-name student: *
Required
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