*If you or your child is currently in 8th grade, please select 'other' as the option answer choice in the following two questions. Please type in the name of the district and school you or your child currently attends in the available space. Thank you!

Some courses have prerequisites. Please check before enrolling. Registration does not guarantee enrollment. If your school is not listed, please contact Kim Carrillo at 909-947-3400 ext.1322 for information on how to register.
Student's Last Name:

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* 5. Student's Last Name:

Student's First Name:

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* 6. Student's First Name:

Address:

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* 7. Address:

City:

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* 8. City:

State:

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* 9. State:

Zip Code:

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* 10. Zip Code:

Date of Birth:

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* 11. Date of Birth:

Student Cell Phone Number:

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* 14. Student Cell Phone Number:

Student Email Address:

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* 15. Student Email Address:

Parent Home/Cell Phone Number:

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* 16. Parent Home/Cell Phone Number:

Parent Email:

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* 17. Parent Email:

Emergency Contact Name:

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* 18. Emergency Contact Name:

Emergency Contact Phone Number:

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* 19. Emergency Contact Phone Number:

How did you hear about Baldy View ROP? Check all that apply:

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* 20. How did you hear about Baldy View ROP? Check all that apply:

Long Student ID# (if known):

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* 21. Long Student ID# (if known):

Thank you for applying to enroll in a Baldy View ROP course! You will receive correspondence when your registration has been confirmed.

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