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Heartland Christian Academy 101 Nations Blvd. Bethel, MO 634349742 Phone: 6602846300 Fax: 8168170391 ___ Application for Admission 202324ENROLLMENT DATE (MM/DD/YY): ___ WITHDRAWN DATE :___(office use only)Full Name:___ ENTERING GRADE:___Home Address: ___Street___/___/___ _________CityStateZip CodeSocial Security NumberPhone Number: ___ Birthdate:___ Age: ___Email:___Which parent should receive communication? Mother Father Guardian
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