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Open House Registration 2019-2020

Please complete the form below. Required fields marked with an asterisk *

Student's First Name:*

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Student's Last Name:*

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Current Middle School:*

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Home Phone Number:*

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Student's Cell Phone Number:

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Student's Email Address:

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Mother's Title*

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Mother's First Name*

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Mother's last name (if different than above)

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Mother's Cell Phone Number:*

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Mother's Email Address:*

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Father's Title*

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Father's First Name

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Father's last name (if different than above)

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Father's Cell Phone Number*

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Father's Email Address*

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Mailing Address:

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Alternate Mailing Address (if applicable):

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Did you receive our postcards in the mail?*

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Yes

How did you hear about Shulamith High School?

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