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To register, Community Connections Academy ask you to fill out the form below.

New Student

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Returning Student

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How Did You Hear About Us?

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Name:

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Date of Birth:

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Social Security Number:

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Home Address:

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Email:

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Home Phone:

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Cell Phone:

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Emergency Contact Name:

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Relationship:

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Phone Number:

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High School Name & Location:

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College Name & Location:

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Other Name & Location:

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PAY HERE $600