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I am a (check one):

Student Parent Teacher

Note: Students must reside in the city of Chicago in order to attend ChiArts; proof of residency for entry in the 2010-11 school year is required by July 1, 2010.

If student... my parent's name is:

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I will start my freshman year of high school in September of:

2010 2011 2012

My address is:

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Area of Interest (check all that apply):

Music Dance Theatre Visual Arts

Instrument or voice part (if applicable):