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All fields are REQUIRED, unless noted by an (*) ASTERISK.
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Parent/Guardian Contact Information
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| Parent First Name |
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| Parent Last Name |
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| Email |
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| Home Phone |
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| Street Address |
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| City |
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| State |
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| Zip |
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| Preferred Method of Contact |
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| First Name |
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| Last Name |
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| Date of Birth |
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| Grade Level in 2025-26 |
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| Has your child previously attended the after school program at this school? |
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| Submit registration packet using online form or mailed packet? |
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| Type of Program Needed: |
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| Days of the week the student will attend the program: |
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| Is your child a homeless or foster youth? |
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| Does your child require any special accommodations? |
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