Parent Contact Name (This will serve as an electronic parent signature, indicating permission to participate in virtual and remote learning) *
Your answer
Parent Email Address that you check regularly *
Your answer
Parent Contact Number *
Your answer
Mailing Address, including address, city, state, zip code *
Your answer
Please list any health needs or special accommodations that we need to be aware of: *
Your answer
Student Date of Birth *
Your answer
Math Teacher *
Your answer
English Teacher *
Your answer
Parent/Guardian Names *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Work Phone *
Your answer
Emergency contact if parent/guardian cannot be reached in an emergency situation: Name and phone # *
Your answer
There will be no 21st Century Grant transportation provided this year. Student must provide own transportation to CVCC or other class locations. My child will... *
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