Student Information

Your student's First Namerequired

Your student's Last namerequired

Male Female

Student's Current Grade:required

Name of your student's current schoolrequired

Applying for Graderequired

Parent/Guardian Information

Parent/Guardian 1 First Namerequired

Parent/Guardian 1 Last Namerequired

Parent/Guardian 1 Relationship to Studentrequired

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Relationship to Student

Street Addressrequired

Cityrequired

Staterequired

Zip Coderequired

The phone number where it is easiest to reach yourequired

Home Cell Work

Email Addressrequired

Mother Father Other

How many will be attending this event?

1 2 3

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