____________________________________________________________________________________________________

Application for Admission                                                  to________________ Grade

 

I.     STUDENT INFORMATION

Name: ________________________________________________________ Sex: _____ F _____ M

                                      Last                         First                                         Middle

 

Name student goes by: ___________________________________________________

 

Address: ______________________________________________________________________

 

City: ______________________County:__________     State: __________ Zip: ______________

 

Telephone Number: ________________________________________________

 

Age: ___________Date of Birth: ________________ Place of Birth: __________________________

 

School previously attended ___________________________________________________________________

 

Is there anything about the last school year that Midway should know in order to best teach your child?

 

_______________________________________________________________________________

 

 

Brothers and Sisters

Name	Age	Grade	School

 

 

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