Registration Information
The information below must be submitted prior to your student's first day of school.
Email address *
Contact information
Student's Legal First Name *
Your answer
Student's Legal Middle Name *
Your answer
Student's Legal Last Name *
Your answer
Nickname (if applicable)
Your answer
Student Birthdate *
MM
/
DD
/
YYYY
Grade *
School Transferred From - Name and City *
Your answer
Resident School District *
If other what district?
Your answer
Check any of the following programs that apply
Home Address - include street address, city, state and zipcode *
Your answer
Primary contact phone number - note this number will be used to receive updates such as weather closings. *
Your answer
Type of phone number
Student lives with: *
Required
Others living in student's residence - name, relation and age
Your answer
Parent 1/Guardian First Name *
Your answer
Parent 1/Guardian Last Name *
Your answer
Parent 1/Guardian email address *
Your answer
Parent 1/Guardian full mailing address if different than student
Your answer
Parent 1/Guardian cellphone number *
Your answer
Parent 1/Guardian work number
Your answer
Parent 1/Guardian Place of Employment
Your answer
Parent 2/Guardian First Name *
Your answer
Parent 2/Guardian Last Name *
Your answer
Parent 2/Guardian email address *
Your answer
Parent 2/Guardian full mailing address if different than student
Your answer
Parent 2/Guardian Cellphone number *
Your answer
Parent 2/Guardian work number
Your answer
Parent 2/Guardian place of employment
Your answer
Family members who attend JGESA - name and relationship
Your answer
Individuals with permission to pick up your student from school.
In case of emergency/early dismissal/weather/ carpool/after school clubs. Please be inclusive (relative, baby sitter, neighbor, friend), as we cannot release your child to anyone who is not on this list. If your child has an accident or becomes ill & you cannot be reached, one of the individuals listed below will be called. Any individual whom you list below may be asked to show identification in order to pick your child up at JGESA.
Emergency Contact #1 - name, relation and phone number *
Your answer
Emergency Contact #2 - name, relation and phone number *
Your answer
Emergency Contact #3 - name, relation and phone number
Your answer
Emergency Contact #4 - name, relation and phone number
Your answer
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This form was created inside of Jane Goodall Environmental Sciences Academy.