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Student Information
Name
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First
Middle
Last
Jr
Sr
II
III
IV
Suffix
Preferred Name
Date of Birth
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Current School
Current Grade
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
Applying For Grade
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
For school year
24-25
25-26
How can we help you today?
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Primary Contact Parent and Guardian Information
Relationship to Student
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Stepmother
Stepfather
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Grandfather
Guardian
Name
Mr.
Mrs.
Ms.
Dr.
PhD.
Title
First
Last
Jr
Sr
II
III
IV
Suffix
Preferred Name
Mailing Address
Email
Phone
Cell
Home
Work
Type
Number
Alternate Phone
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Home
Work
Type
Number
Thanks for reaching out. Out of curiosity...
How did you hear about Crossroads Academy?
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Current School
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