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Student Application Form

Please complete the student application form below. Required fields marked *

Contact Information

Parent First Name*

Parent Last Name*

Child's First Name*

Child's Last Name*

Child's Current Grade*

Child's Current School

Does your child have an IEP? (IEP students have preference)*

Yes

Does your child have a sibling who attends CAMPA? (Siblings have preference)*

Yes

Home Address

Street Address*

City*

State*

Zip/Postal*

Email 1*

Mobile Phone*

Home Phone

Work Phone