Type Verification? NAME OF PARENTIS) OR L GAL QUARDIAN OR OTHER RESPONSIBLE ADULT AT HOME: G OA BIRTHPLA• P CURRE Name Street City 2, qfjyst Entes h is District yes,/ Withdrawal Date Withdrawal Date Withdrawal Date Gradig $ Cre4 School . Grede. K G,..51. Glii i School Year. 19. 23--