High School Night
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Registration Information
One form for each registrant.
First Name *
Last Name *
Birth Date *
MM
/
DD
/
YYYY
Street Address *
City *
State *
Zip Code *
Home Language *
Race/Ethnicity *
Gender *
Educational Attainment *
School Currently Attending *
Date Started at School
MM
/
DD
/
YYYY
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Grade Level *
Participant Email Address *
Participant Phone # *
Guardian Name *
Guardian Email Address *
Guardian Phone # *
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