ZLO Student Information 2018-2019
Please complete a "Student Information" questionnaire for each registered student, and a *voluntary* student ethnicity questionnaire (no names, just a survey to help satisfy our non-profit agreement).
Student Last Name *
Your answer
Student First Name *
Your answer
Student Date of Birth *
MM
/
DD
/
YYYY
Student Cell Number
Please include area code with phone number
Your answer
Student Email Address
Your answer
Parent Last Name *
Your answer
Parent First Name *
Your answer
Parent Contact Phone *
Please include area code with your phone number.
Your answer
Parent Email Address *
Your answer
Emergency Contact & Phone Number *
If we cannot reach you, who should we contact in case of emergency? Please include name, phone number, and relationship to student.
Your answer
Medical Information *
Please list any allergies (food, seasonal, medications, etc.), or other conditions that teachers and staff should be aware of. Also, in case of an emergency, what information would we need to share with an EMT/Paramedic?
Your answer
Home Address - House Number & Street ONLY *
Your answer
Home Address - City, State ONLY *
Your answer
Home Address - Zip Code ONLY *
Your answer
Photo Release *
Policy: We generally identify students in photos that can appear on our website or Facebook page as "science students," or "car wash helpers." We may use students' first names, but will not use family names (last names) without your permission.
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