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Indian River Middle School Backpack Program Enrollment Form
If registering multiple children, please fill out a form for each child.
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* Indicates required question
Name of Parent(s) or Guardian(s)
*
Your answer
Your Email Address
*
Your answer
Name of Student:
*
Your answer
Age:
*
Your answer
Teacher:
*
Your answer
Grade:
*
Your answer
Please enroll my child in the IRMS Backpack Program.
*
Yes
Required
Please list any food allergies your child has:
Your answer
Please check below how your child gets home from school on a regular basis:
*
Parent pick-up
2:30 bus run
3:30 bus run
4:00 bus run
5:00 bus run
Other:
Required
Please list the name(s) and age(s) of other children in the household that are under the age of 18:
Your answer
Signature:
*
Your answer
Date:
*
MM
/
DD
/
YYYY
Questions/comments/interest in assisting with the program? Call 642-0131 (Student Services).
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