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Student's Name (required):
Student's Age (required):
Grade of School the student will be entering: ---PreschoolKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th GradeAbove 6th Grade
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Please check all food allergies that apply:
Peanut Tree nuts Milk Egg Wheat Soy Fish Shellfish
Other Allergies if applicable:
Guardian's Email: (required)
Emergency Contact Name: (required)
Emergency Contact Phone Number: (required)
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