Out of Grade Range Exception Request

Please provide complete information

Parent Name (Registered under)
	Last Name:
	First Name:
Parent Cell Phone Number:
Student Name
	Last Name:
	First Name:
	Birth Date:	please select a date!
	Student Grade Level during the academic year of THIS class:	12 11 10 9 8 7 6 5 4 3 2 1 Kindergarten Preschool
	Student Age as of the first day of Legacy's academic year for THIS class:
Class Info
	Teacher Name:
	Class Title:
	Class Hour:
	Grade Range:
Reason/Explanation for Exception Request