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Community Club Student Registration Form
If you have any questions about this form, please contact Phil Telfeyan at ptelfeyan@communityclub.org.
Please use initial capitalization on proper nouns.
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* Indicates required question
First and Last Name
*
Enter the student's first and last name (not middle name). Please use initial capitalization.
Your answer
E-mail
*
What is the student's e-mail address?
Your answer
Primary Phone
*
What is the student's primary phone number? Please format as (234) 567-8910.
Your answer
Grade
*
What is the student's current grade?
alum
12
11
10
9
8
7
6
5
4
3
2
1
K
inactive
Registration Date
*
In-person registration for students is
held every Thursday from August through April at 6:45pm at 1313 New York Avenue NW. What date will the student come in-person to register? (No minimum advance notice is required; even if registration is today, you can come to any time listed here.) Please come on the date you specify; we rely on your answer here as your RSVP.
Choose
Thursday, October 15 at 6:45pm
Thursday, October 22 at 6:45pm
Thursday, October 29 at 6:45pm
Thursday, November 5 at 6:45pm
Thursday, November 12 at 6:45pm
Gender
*
What is the student's gender?
female
male
other
Elementary School
*
Where did/does the student attend elementary school?
Your answer
Middle School
Where did/does the student attend middle school?
(If not yet in middle school, write "N/A".)
Your answer
High School
Where did/does the student attend high school? (If not yet in high school, write "N/A".)
Your answer
High School Class
*
What year will/did the student graduate high school?
Your answer
College
Where did/does the student attend college?
(If not yet admitted to college, write "N/A".)
Your answer
Hobbies
What are the student's hobbies?
Your answer
Favorite Subjects
What are the student's favorite subjects?
Your answer
Hardest Subjects
What are the hardest subjects for this student?
Your answer
Referred
How did the student find out about Community Club?
Your answer
Full Home Address
*
What is the student's **full** home address (please include street number, name, quadrant, city, state, and ZIP code)?
Your answer
Guardian #1
*
What is the name of Guardian #1?
Your answer
Guardian #1 Relation
*
How is Guardian #1 related to the student?
Your answer
Guardian #1 E-mail
*
What is Guardian #1's e-mail address?
Your answer
Guardian #1 Phone
*
What is Guardian #1's phone number?
Please format as (234) 567-8910.
Your answer
Guardian #2
What is the name of Guardian #2?
Your answer
Guardian #2 Relation
How is Guardian #2 related to the student?
Your answer
Guardian #2 E-mail
What is Guardian #2's e-mail address?
Your answer
Guardian #2 Phone
What is Guardian #2's phone number?
Please format as (234) 567-8910.
Your answer
Live-In Family
Who lives in the same home as the student? Please include name, relation, and age.
Your answer
Other Siblings
What siblings do not live with the student?
Please include name, relation, and age.
Your answer
CC Family
What family members have attended or are attending Community Club? Please include name, relation, and years attended.
Your answer
Class List
What classes is the student currently taking?
Your answer
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