Regular Education Registration 2017
Please provide the following information to register your child for summer school. Be sure to download the emergency contact form and/or medication form and send to Kristin Robertson at Mill Pond School.
Student's last name *
Your answer
Student's first name
Your answer
Student's gender *
What is your student's CURRENT grade in school? *
What school does the student currently attend? *
Who is the student's current teacher? *
Your answer
Name(s) Parents/Guardian(s) *
Your answer
Home Phone Number *
Your answer
Cell Phone Number *
Your answer
Email *
Your answer
Address *
Your answer
Choose which program(s) your child will attend. Only choose the program(s) your child was recommended for. *
Required
In case of emergency, who should the nurse contact if parents are unavailable? Please include phone number.
Your answer
Does your child have allergies? If so, please list.
Your answer
What is your doctor's name and phone number? *
Your answer
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