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Adult 1
Adult 2
Mailing Address
Physical Address (if different from Mailing Address)
Please describe allergies and medications as applicable.
Please offer any additional notes on your student that will be worth noting to our educator. Please include any behavioral notes, notes from an IEP if applicable, and best practices from school or home to engage your student. All details will be confidential.
Does the WRJC have permission to include photographs of your student(s) in emails, printed publications, and social media accounts?
Thank you! We look forward to learning together with your student.