Lottery Enrollment Form

20182019 School Year

Please provide the following information:

Parent Information  
Mother's First Name
Mother's Last Name
Street Address
Address (cont.)
City
State
Zip
Work Phone
Home Phone
   
Father's First Name
Father's Last Name
Street Address
Address (cont.)
City
State
Zip
Work Phone
Home Phone
Student Information
Student #1  
First Name
Last Name
Boy/Girl
Date of Birth
Grade for 20182019 school year
Current School
   
Student #2  
First Name
Last Name
Boy/Girl
Date of Birth
Grade for 20182019 school year
Current School
   
Student #3  
First Name
Last Name
Boy/Girl
Date of Birth
Grade for 20182019 school year
Current School

     

 

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