Parent/Guardian Name *
Relationship*
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Parent
Grandparent
Step Parent
Guardian
Phone Number *
Email*
Zip Code*
Son's Name*
Son's Current Grade*
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6
7
8
9
10
11
12
Inquiry Grade*
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8
9
10
11
12
PG
Date of Birth*
Interests
STEM
Robotics
Writing
History
Science
Art
Soccer
Cross-Country
Golf
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Tennis
Baseball
Other
Referral Source
Google/Search Engine
Social Media
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Education Website
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Additional Comments