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5th Grade-Saturday
Pre- Registration
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* Indicates required question
ICLI
Father's/Guardian's First name
*
Your answer
Father's/Guardian Last name
*
Your answer
Mother's/Guardian First Name
*
Your answer
Mother's/Guardian Last Name
*
Your answer
Home Phone Number
*
Your answer
Cell Phone Number
*
Your answer
Email
*
Your answer
2nd Email
Your answer
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Home Address # and street
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
Does your Child have any allergies we should be aware of?
*
Your answer
Does your Child have any special needs we should be aware of?
Your answer
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