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Registration
Social Security:
Day Care:
Pre-K:
School:
Grade/Grado:
Student Information
Name/Nombre:
Last Name:
Apellido:
Reg. Date:
Fecha de Matricula:
Address
Direccion:
Ciudad:
City:
State:
Estado:
Zip Code:
Codigo Postal:
Telephone
:
Religion:
Sexo/Gender:
Date of Birth:
Fecha de Nacimiento:
Select
January
February
March
April
May
June
July
August
September
October
November
December
Place of Birth:
Lugar de Nacimiento:
Last School Attended:
Ultima Escurla que Asistio:
Address/Direccion:
Ciudad/City:
State:
Estado:
Zip Code:
Codigo Postal:
Family Information
Father's Name:
Nombre del Padre:
Father's Last Name:
Apellido del Padre:
Race:
Raza:
Select
Afro-American
Asain
Hispanic
White American
Address/Direccion:
Ciudad/City:
State:
Estado:
Zip Code:
Codigo Postal:
WorkTelephone:
HomeTelephone:
Mother's Name:
Nombre del Madre:
Mother's Last Name:
Apellido del Madre:
Race:
Raza:
Select
Afro-American
Asain
Hispanic
White American
Address/Direccion:
Ciudad/City:
State:
Estado:
Zip Code:
Codigo Postal:
Student lives with:
Alumno vive con:
Select
Padre
Madre
----------
Father
Mother
Authorized to pick-up
Name/Nombre:
Last Name: Apellido:
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