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Kaizen Academy Application

Student Information
Parent Infomation
Emergency Contact

Enrollment

School Year

About Student

Name *

First

Last Name

Last

Address *

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Country

Country

Date of Birth *

Gender

Phone *

Format: 1 (242) 555-5555

Does your child have allergies?

Yes

No

Please describe and list accommodating medications.

Admissions Open!

Fall 2021-2022; Grades 1-6