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Student Application
Registration for Gator All-Star Academy - GASA (Waycross Middle School)
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* Indicates required question
Student's Full Name:
*
Your answer
Student's Current Grade:
*
6th
7th
8th
Is the student a car or bus rider?
*
Car Rider
Bus Rider
Student's Homeroom Teacher:
*
Your answer
Student's Home Address (Please include City and State):
*
Your answer
Student's Mailing Address (If different than above) (Please include City and State):
*
Your answer
Primary Parent or Guardian's Name:
*
Your answer
Primary Parent or Guardian's Cell Number:
*
Your answer
Primary Parent or Guardian's Work Phone:
*
Your answer
Primary Parent or Guardian's Place of Employment:
*
Your answer
Primary Parent or Guardian's Email Address:
*
Your answer
Secondary Parent or Guardian's Name:
*
Your answer
Secondary Parent or Guardian's Cell Number:
*
Your answer
Secondary Parent or Guardian's Work Number:
*
Your answer
Secondary Parent or Guardian's Place of Employment:
*
Your answer
Secondary Parent or Guardian's email address:
*
Your answer
Does the student have any medical conditions or allergies? (If you answer "yes" there will be an additional Medical Form.)
*
Yes
No
Is there anything else that we should know about the student?
*
Your answer
What subject(s) does your student need help? Check all that apply. *Not all subjects have a tutor represented.
*
Math
English/Language Arts
Science
Social Studies
Required
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