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Parent / Guardian Information
First Parent / Guardian
First Name
*
Last Name
*
Salutation
*
Col.
Dr.
Fr.
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Mr.
Mrs.
Ms.
Sr.
Email Address
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Confirm Email Address
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(Ex: 999-999-9999)
Home Phone
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Student
Details:
Student 1
First Name
*
Middle Name
Last Name
*
Birthdate
*
(mm/dd/yyyy)
Gender
Female
Male
Grade Level of Interest
*
PK2 - Child must be 2 before starting
PK3 - Child must be 3 by 9/2
PK4 - Child must be 4 by 9/2
K - 5 on or before 9/2
01
02
03
04
05
06
07
08
School Year
*
2024-2025
2023-2024
Current School
Is There Another Student?
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Parent / Guardian Notes