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About the Student
Name
First
Middle
Last
Jr
Sr
II
III
IV
Suffix
Preferred Name
Gender
Date of Birth
dd/mm/yyyy
Current Grade
Not yet in school
JK
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Interested in Grade
JK
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Schedule Interest
Full Day
Half Day
For the Fall of
2023-2024
2024-2025
2025-2026
Current School
About the Parent/Guardian
Name
Mr.
Mrs.
Ms.
Dr.
Title
First
Middle
Last
Jr
Sr
II
III
IV
Suffix
Preferred Name
Relationship to Student
Mother
Father
Stepmother
Stepfather
Grandmother
Grandfather
Guardian
Primary Phone (xxx-xxx-xxxx)
Cell
Home
Work
Type
Number
Email
Broadening Horizons
Interests
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