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Christian Academy

Information Request

Parent or Guardian

First name

Last name

Email

Phone

Street Address

City

State

Zip Code

Gender

Relationship to future student(s)

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Student 1 Information

(please fill out all of the information)

First Name

Last Name

Gender

Birthdate

example: 01-JAN-2020

Grade Level Going Into

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Student 2 Information

(please fill out all of the information)

First Name

Last Name

Gender

Birthdate

Grade Level Going Into

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Student 3 Information

(please fill out all of the information)

First Name

Last Name

Gender

Birthdate

Grade Level Going Into

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How did you hear about us?

Additional Questions/Comments

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