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High School-RETURNING Student Information Form
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https://secure.ezmealapp.com/ApplicationScreen.aspx
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Email *
Student Name-Last *
Student Name-First *
Student Nickname (can enter NA if not applicable) *
New Physical Address *
Physical Address *
City & State *
Zip Code *
New Mailing Address *
Mailing Address-Street,  City, State,  Zip Code *
Parent 1- First & Last Name *
Parent/Guardian 1 Relationship *
Does student reside with this parent/guardian? *
Parent 1- Contact #-ex: 000-000-0000 *
Parent 1- Alternate Phone
Parent or Contact email *
Parent 2- First & Last Name
Parent/Guardian 2 Relationship *
Does student reside with this parent/guardian? *
Parent 2 Mailing Address IF DIFFERENT FROM PARENT 1-Street,  City, State,  Zip Code
Parent 2- Contact #-ex: 000-000-0000
Parent 2-Alternate Phone
Emergency 1 Contact Name (OTHER THAN PARENT/GUARDIAN): First & Last *
Emergency 1 Contact Relationship to Student *
Emergency 1 Contact Number- ex: 000-000-0000 *
Emergency 2 Contact Name (OTHER THAN PARENT/GUARDIAN): First & Last
Emergency 2 Relationship to Student
Emergency 2 Contact Number- ex: 000-000-0000
Name  and Phone # of Anyone Who IS ALLOWED to Check Your Student Out *
Parent/Guardian Signature-Typing your name is equivalent to signing. *
Date *
MM
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DD
/
YYYY
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