Kindred Bakery - New Student Form
This form asks information about you, and whoever we need to contact to help you. The information here will be kept private by Kindred Bakery, used only be staff.
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First Name *
Your FIRST name
Last Name *
Your LAST name
Date of Birth *
Your Date of Birth
MM
/
DD
/
YYYY
Data Entry Help *
Choose how you will enter data in class. "Self" means no help. "Helper" means someone helps you. "Paper" means someone else enters it for you.
Primary Disability *
What, if any, is the primary disability we should know about?
IEP = Individual Education Plan
504 = Has a Medical Diagnosis
Which Section are you Interested in? *
Current Job Status *
What is the current employment status of the student? We're asking about paid employment, either full-time or part-time.
Race *
These are the official New York Categories
Preferred Pronoun *
Medical Condition *
Do you have a medical condition? If you do, please describe it in the optional next question.
Medical Condition Description
Not required
Allergies *
Do you have an allergy? If you do, please describe it in the optional next question.
Allergy Description
Not required
Email *
Your email, or someone who receives for you. Write "None" if none available
Phone *
Your Phone #, or someone else for you.  Be sure to put in Dashes (-) as in 111-222-3333
Zipcode *
Your 5-digit Zipcode
Emergency Contact Name *
Who we should contact in an emergency.
Emergency Contact Phone *
The Phone # for us to call in an emergency.  Be sure to put in Dashes (-) as in 111-222-3333
School Coming From *
What school are you in now, or did you most recently attend?
City Councilperson
The name of your city council person - Not required, but helps us.
Notes
Anything else we should know about you.
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