Enrollment

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Summer Student Enrollment Form_High school

Student Details

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First Name

Middle Name

Last Name

DOB

Current Grade

School Currently Attending

Academic Strengths & Weaknesses

Goal For Attending School

Home Address

Email

Parent Details

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First Name

Middle Name

Last Name

Email

Home/Work Phone Number

Cell Phone Number

First Name

Middle Name

Last Name

Email

Home/Work Phone Number

Cell Phone Number

With whom does the child live with?

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