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| STUDENT INFORMATION |
| *Student Name: |
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| Sex: |
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| Birthdate (mm/dd/yy): |
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| School year: |
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| Grade Interested in: |
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| Current School: |
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| Is the sibling of the applicant currently attending this school? |
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| If yes, please provide student's name: |
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| If a sibling will be pre-enrolling as well, please provide the following information: |
| Sibling Name: |
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| Sex: |
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| Birthdate (mm/dd/yy): |
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| School year: |
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| Grade Interested in: |
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| Current School: |
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| Second Sibling Name: |
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| Sex: |
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| Birthdate (mm/dd/yy): |
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| School year: |
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| Grade Interested in: |
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| Current School: |
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| PARENT/GUARDIAN CONTACT INFORMATION: |
| Salutation: |
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| Mother First Name: |
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| Mother Last Name: |
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| Salutation: |
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| Father First Name: |
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| Father Last Name: |
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| *Address 1: |
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| Address 2: |
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| *City: |
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| *State: |
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| *Zip: |
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| *Home Phone: |
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| Work Phone: |
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| Mobile Phone: |
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| *Email Address: |
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| Preferred contact method? |
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| *How did you learn about Imagine Charter School at St. Petersburg? |
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| If you would like additional information or have other questions, please enter here: |
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| Enter your email address here if you would like to receive a confirmation email: |
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| Enrollment is based upon a space-available basis. We will confirm upon receipt of the enrollment package. |
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