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Application for admission
LOWER ELEMENTARY
STUDENT'S INFORMATION
Student First Name
Student Last Name
Student Middle Name
Date Of Birth
Gender
Male
Female
Home Address
City
State
Zip
FAMILY INFORMATION
Father's Name/Guardian
Relationship(Other than Father)
Occupation
Business Work
Cell Phone
Work Phone
Home Phone
Email
FAMILY INFORMATION
Mother's Name/Guardian
Relationship(Other than Mother)
Occupation
Business Work
Cell Phone
Work Phone
Home Phone
Email
PROGRAM INFORMATION (SELECT 1)
Program information
Program information GRADE 1
Program information GRADE 2
Program information GRADE 3
Program information GRADE 4
Program information GRADE 5
Program information GRADE 6
EMERGENCY 1ST CONTACT INFORMATION
First Name
Last Name
Middle Initial
Relationship
Gender
Male
Female
Home
City
State
Zip
Phone(Primary)
Phone(Secondary)
Email
EMERGENCY 2ND CONTACT INFORMATION
First Name Emergency contact (other than parents)First Name
Last Name
Middle Initial
Relationship
Gender
Male
Female
Home
City
State
Zip
Phone(Primary)
Phone(Secondary)
Email
AUTHORISED FOR PICK-UP CONTACT 1
Authorized for pick-up Name 1
Phone
Relationship
Email
AUTHORISED FOR PICK-UP CONTACT 2
Authorized for pick-up Name 2
Phone
Relationship
Email
AUTHORISED FOR PICK-UP CONTACT 3
Authorized for pick-up Name 3
Phone
Relationship
Email
SIGNATURE OF PARENT OR GUARDIAN
Printed Name of the Parent
Date
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PTC scheduler
Yellow & Green Room Field Trip Form
Blue & Gray Room Field Trip Form
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