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Pre-Registration

Please fill out and submit the following pre-registration information.

All fields below are required
School Selection
Are you a returning student?: Yes No

Please select your campus choices: Please select your session choices:
First Choice:
First Choice:
Second Choice:
Second Choice:
Third Choice:
Third Choice:
Student Information
Last Name:   First Name:
SSN:
Date of Birth: / / Age:
Birth City, State: , Country:
Gender: Ethnicity:
Address:
City: Zip:
Home Phone: ()
Last School Attended:
All fields above are required.
Fields below are optional but will be required at a later date.
Mother's Contact Information
First Name: Last Name:
Work Phone: () ext:
Home Phone: ()
Cell Phone: ()
Address:
City, State: , Zip:
Father's Contact Information
First Name: Last Name:
Work Phone: () ext:
Home Phone: ()
Cell Phone: ()
Address:
City, State: , Zip:
Guardian's Contact Information
First Name: Last Name:
Work Phone: () ext:
Home Phone: ()
Cell Phone: ()
Address:
City, State: , Zip:
Emergency Contact Information
First Name: Last Name:
Relationship: Contact Phone: ()
By pressing the Submit button below, you are authorizing IntelliSchool to request any and all student records. Requested records may include any special education and confidential records (including, but not restricted to, psychological reports, I.E.P.'s, psychiatric reports and any other pertinent records), for the sole purpose of providing appropriate educational services for the student.

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