M.S. 319 Maria Teresa Mirabal

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Student Registration (MS319)

Student Information

Legal First Name*

Answer required for "Legal First Name"

Legal Last Name*

Answer required for "Legal Last Name"

Grade Entering*

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Date of Birth*

Answer required for "Date of Birth"

First language spoken by student*

Answer required for "First language spoken by student"

Languages spoken at home*

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Address

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

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Home Phone*

Number Required

Parent 1 Information

First Name*

Answer required for "First Name"

Middle Name

Answer required for "Middle Name"

Last Name*

Answer required for "Last Name"

Email*

Answer required for "Email"

Mobile Phone*

Number Required

Alternate Phone

Number Required

Parent 2 Information

First Name*

Answer required for "First Name"

Middle Name

Answer required for "Middle Name"

Last Name*

Answer required for "Last Name"

Email*

Answer required for "Email"

Mobile Phone*

Number Required

Alternate Phone

Number Required

Emergency Contact Information

First Name*

Answer required for "First Name"

Middle Name

Answer required for "Middle Name"

Last Name*

Answer required for "Last Name"

Relationship to Student*

Answer required for "Relationship to Student"

Email*

Answer required for "Email"

Phone*

Number Required

Confirmation Email

Confirmation Email

Answer required for "Confirmation Email"