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Student Registration Application
To register, please take the time to fill out the information below.
Child's First Name
Child's Last Name
Address
City/Town
State
Zipcode
Gender
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Does this child have any medical conditions, physical limitations, allergies or special needs?
Choose an option
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To better serveyour child, please indicate if he/she has been diagnosed with any of the following
ADD/ADHD
Convulsions
Bleeding/Clotting Disorders
Autism
Aspergers
Fragile X
Cerebal Palsy
Bipolar Disorder
Tourettes
Rhett Syndrome
Down Syndrome
Chronic Health Problems
Asthma/ Sever Allergies
Diabetes
Heart defect/disease
Other
None
If you selected other, list below.
If you have your child's immunization records, please upload
Upload File
Upload supported file (Max 15MB)
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