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(832) 400-4607
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Summer Program Registration Form
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Registration
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Student's Last Name
Email
Student's Date of Birth
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Upcoming Grade Level
Pre-K/Kindergarden
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Select special assistance if needed:
ESL
Reading & Math Enhancement
Special Ed. / Small Group
(7th-12th Grade, please select 1 math and/or 1 science course you will be taking in FALL 2023)
Algebra 1
Algebra 2
Biology
Chemistry
Geometry
PSAT/SAT Prep
Does your child have any allergies or medical conditions that need attention?
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If yes, please explain. If no, enter 'NA':
(1) Parent/Guardian's First Name
(1) Parent/Guardian's Last Name
(1) Parent/Guardian's Driver License Number
(1) Parent/Guardian's Date of Birth
(1) Parent/Guardian's Cellphone
(1) Parent/Guardian's Email
(2) Parent/Guardian's First Name
(2) Parent/Guardian's Last Name
(2) Parent/Guardian's Driver License Number
(2) Parent/Guardian's Date of Birth
(2) Parent/Guardian's Cellphone
(2) Parent/Guardian's Email
Home Address
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ZIP Code
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