Registration Form
One form per family needs to be filled out.
Last Name
Your answer
Father's Name
Your answer
Mother's Name
Your answer
Street Address
Your answer
City
Your answer
Zip
Your answer
Father's Cell #
Your answer
Mother's Cell#
Your answer
Email address (to receive newsletter & correspondence)
Your answer
Alternate email address
Your answer
Non-Parent Emergency Contact (Name & phone #)
Your answer
Relationship to Non-Parent Emergency Contact
Your answer
Preferred Hospital
Your answer
Physician's Name & phone #
Your answer
The following children are registering with AACE:
Child #1 Name
Your answer
Date of Birth
Your answer
Age
Your answer
Grade
Your answer
Child's email address
Your answer
Cell phone #
Your answer
Homeschooled Since
MM
/
DD
/
YYYY
Last School
Your answer
Health/Medical Concerns
Your answer
Child #2 Name
Your answer
Date of Birth
Your answer
Age
Your answer
Grade
Your answer
Child's email address
Your answer
Cell phone #
Your answer
Last School
Your answer
Homeschooled Since
MM
/
DD
/
YYYY
Health/Medical Concerns
Your answer
Child #3 Name
Your answer
Date of Birth
Your answer
Age
Your answer
Grade
Your answer
Child's email address
Your answer
Cell phone #
Your answer
Last School
Your answer
Homeschooled Since
MM
/
DD
/
YYYY
Health/Medical Concerns
Your answer
Child #4 Name
Your answer
Date of Birth
Your answer
Age
Your answer
Grade
Your answer
Child's email address
Your answer
Cell phone #
Your answer
Last School
Your answer
Homeschooled Since
MM
/
DD
/
YYYY
Health/Medical Concerns
Your answer
I understand that ALL information provided to AACE, Inc. is confidential and will only be used for school-related purposes. (please print name & date to acknowledge)
Your answer
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