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First Name of Student:
Last Name of Student:
Middle Name of Student:
Place of Birth:
Student Resides with:
Date of Birth:
Relationship to Student:
Are there any medical concerns we need to know about?
What was the last school you attended?
Complete Name of School:
Are you an out of district student?
If yes, what district do you reside in?
I have received a copy of the student handbook?YesNo