ADMISSION APPLICATION
STUDENT NAME
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First Name
Last Name
Date of Birth
SOCIAL SECURITY
Grade Level
RACE
ETHNICITY
ALLERGIES (FOOD, MEDICATIONS, ETC):
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Address
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Street Address
Street Address Line 2
City
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Postal / Zip Code
PARENT / GUARDIAN # 1
*
Full Name
Relationship
Contact Number
Contact Email
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PARENT / GUARDIAN # 2
Full Name
Relationship
Contact Number
Contact Email
Occupation
Work Phone
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact
Name
Contact Number
Relationship
Emergency Contact
Name
Contact Number
Relationship
Parent Signature
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