Student Name *

One form per student

First Name

Last Name

Student Cell Phone *

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What grade are you entering? *

4th

5th

6th

7th

8th

9th

10th

11th

12th

What is the best way to share upcoming events and reminders with you? *

You may check more than one box

Text

Email

My parents

All of the above

Did you add Mrs. Miller’s email and cell (youthcoord@flemingtonpres.org and 908-329-5079) to your contacts? *

Yes

No

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Cell Phone *

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