Student Intake Form

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Student Intake Form

Thank you for taking the time to complete this form. Collecting this information will help ensure your child has a wonderful time while visiting Rancho Compasión!

Email *

Student Name *

Student Age *

Student Grade *

School Attended *

Parent/Guardian Name *

Parent/Guardian Email *

Parent/Guardian Primary Phone Number *

Emergency Contact Name *

Emergency Contact Relation to Student *

Emergency Contact Phone Number *

Does the student have any allergies?
*

Yes

If your child has any allergies please specify to what, and whether they have an Epi Pen.

Is your student currently taking any medications? *

Yes

If your child is taking any medications, please provide more details here.

Is our staff permitted to take photos and/or videos of your student on site? Photos and videos may be used on our website and social media, in fundraising efforts, etc.

Yes

Other:

What is your student’s favorite food?

What is your student’s favorite animal?

What is your student most looking forward to doing in the garden?

Which of our residents is your student most excited to meet?

If there is any addition information you would like to share, or any questions you have prior to your student's visit, please include here.

Send me a copy of my responses.

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