Student Register – Korean American Special Education Center

Programs

$ 기부 금액입니다:

기부 금액 선택:

Student Information

Student's Legal Name

Student Nickname

Date of birth

Grade

Gender

Diagnosis

Allergy

Any other medical issues?

Any behavioral issues?

What school program is your child a part of?

Yes No

Student t-shirt size (Adult size)

Parent / Guardian

Legal Name

Relationship

Other

Phone Number

Email Address

개인 정보

이름 *

성

이메일 주소: *

청구 세부 정보

국가 *

주소 1 *

주소 2

도시 *

주 *

우편 번호 / 우편 번호 *

약관

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기부 총액입니다: $1.00

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