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Student Form
Student's Full Name
*
Date of Birth
*
Current Grade
*
Current School
*
Start Date
*
Please provide us with the specific days your child will be attending the program
*
Allergy & Medical History
*
Parent's Full Name
*
Address
*
Email
*
Phone Number
*
Emergency Contact Info
*
Phone Number
*
Email
*
How did you hear about us?
I, Parent/Guardian of the applicant, have read and fully understood the Enrollment Policy & Liability Waivers. By checking this box, I confirm that I will abide by
all the terms
*
I, Parent/Guardian of the applicant, have read and fully understood the Enrollment Policy & Liability Waivers. By checking this box, I confirm that I will abide by all the terms
I accept
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