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- Date of Birth*
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Format: (000) 000-0000.
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Format: (000) 000-0000.
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Format: (000) 000-0000.
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Format: (000) 000-0000.
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- MEDICAL WAIVER AND LIABILITY RELEASE*
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- Please indicate your enrollment type.*
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- 1PM - 2PM*
- 2PM - 3PM*
- 3PM - 4PM*
- 4PM - 5PM*
- 5PM - 6PM*
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- Off-Site Class Selection
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- Medina Homeschool POD Involvement*
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- PARENT VOLUNTEER REQUIREMENT: One parent from each household is required to volunteer up to 5 hours per semester to help our program run smoothly. Tasks may include hallway monitoring, assisting with student sign-in/sign-out, or helping with classroom transitions and events. A background check is required for all volunteers and must be completed before your assigned shift.*
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- Should be Empty: