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Parent/Guardian Information:

First and Last Name of Parent or Guardian completing this form: A value is required.A value is required.

Parent or Guardian: E-mail address: Invalid format.

Student Information: (Legal name including any suffixes, e.g. Jr. or III)

Legal First Name: A value is required.

Middle Initial:

Legal Last name including any suffixes, e.g. Jr. or III: A value is required.

Nickname (if other than legal name): (for our name tents in the class)

Gender:

Female
Male

Street Address: A value is required.

PO Box (if any):

City:

ZIP: Zip code is required.Invalid format.

Home Phone # Phone number is required.

Emergency Contact Phone #:

Emergency contact Name:

Emergency Contact Relationship to student:

Student Date of Birth: A value is required. ex.: MM/DD/YYYY

High School:

Class Date to start: Select one... **December 19, 2011** January 9, 2012 January 23, 2012 February 6, 2012 February 20, 2012 Please select a valid item. Please select an item.

Parent: Have you previously attended ODS with another child?

YES
NO

Please note below the name of the previous child within your household who attended ODS within the last three years to qualify for the Family Alumni Discount.

COMMENTS: (Anything else you would like us to know or any questions)

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