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Fields denoted with an asterisk (*) are required fields.
* Student Name
* Campus
Ben Milam Elementary
Cameron Elementary
Cameron Junior High
C. H. Yoe High School
* Grade
* Home Address
* City
* Zip Code
* Telephone Number
* Parent/Guardian Name
* Parent/Guardian Name
Cell Phone Number
Reply E-mail
* Emergency Contact Name
Relationship to Child
* Emergency Contact Number
Emergency Contact Cell
Emergency Contact E-Mail
Address Other than Home
Address of Licensed Day Care, Designated GrandParent and/or Campus For Staff Shuttle Fill this Section Only If Student is to Be Delivered to Address other than Home
Care Provider Name
Care Provider Phone Number
Relationship to Child
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