DASD Registration Appointment Request Form

Please fill out the following information:

Parent/Guardian's First Name *

Parent/Guardian's Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Is the student(s) currently residing at this address? *

Yes

No

If no, when will the student(s) be residing at this address?

Phone Number *

Email Address *

Desired school start date (MM/DD/YYYY) * +

How many children are you registering? *

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