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Trimester #3: BEACON Moab Charter School Registration
T3 Registration
Contact:
Benjamin Oberhand
BEACON Site Coordinator @ MCS
435.260.0720
Ben@moabcharterschool.org
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* Indicates required question
Email
*
Your email
Student Information
Student Name (First & Last)
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Will this be your child's first Trimester of BEACON this year?
*
No
Yes
Contact Information has changed for my child
Teacher
*
Choose
Kindergarten: Mrs. Carrie Anne
1st Grade -Mrs. Jamie
2nd Grade: Mrs. Lexi
3rd Grade: Mrs. Josie
4th Grade: Ms. Krissy
5th Grade: Ms. Stacia
6th Grade: Ms. Bettina
Home Address
*
Your answer
Ethnicity
*
African American
Asian
Caucasian
Latino/Hispanic
Native American
Other
Required
Dietary Restrictions/Allergies
*
No Known Allergies
Other:
Required
Current Medications
*
Not Applicable
Other:
Required
Specific needs/Other relevant info
Your answer
Individualized Education Program (IEP)
My Child has an IEP (This information allows us to best meet the needs of your child.)
Payment is due upon Confirmation of Enrollment.
*
My child is full pay
My child receives reduced lunch
My child receives free lunch
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