Mandatory Blue Card
Please review and fill out the form below to give us the information we need to best support your child.
Email address *
Preferred e-mail *
Student Last Name *
Student First Name *
Student Home Address (Please provide a FULL address- example: 138-11 35th Avenue, Apt 2A, Flushing NY 11354) *
Student OSIS (ID) number
Student Date Of Birth *
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Student Cell Phone Number *
Student's personal email address
Student's grade in September 2020 *
Parent/Guardian #1 FIRST & LAST Name *
Parent/Guardian #1 FULL Home Address (Please provide a FULL address- example: 138-11 35th Avenue, Apt 2A, Flushing NY 11354) *
Parent/Guardian #1 Cell Phone Number *
Parent/Guardian #1 Email Address *
Parent/Guardian #2 FIRST & LAST NAME
Parent/Guardian #2 FULL Home Address (Please provide a FULL address- example: 138-11 35th Avenue, Apt 2A, Flushing NY 11354)
Parent/Guardian #2 Cell Phone Number
Parent/Guardian #2 Email Address
Does this child have any siblings in NYC schools? If so, please list their name and school.
Language(s) spoken at home *
Language(s) in which the parent/guardian reads and writes. *
Who does the parent/guardian authorize to pick up students from the school in the event of an EMERGENCY? Must Include: FIRST & LAST Name, Relationship to Student, and Cell Phone #. You MUST include at least one person, UP TO 3 People. *
Is there anyone who CANNOT have access to the student? If YES, First & Last Name MUST be included. If No, please write "NONE" *
Name of Student's Physician/Clinic & Telephone Number. If none, please write "NONE" *
HEALTH ALERT: Does the student have any health condition that may affect participation in physical activities? Please include limitations (stair climbing, participation in gym, etc) and ANY ALLERGIES student may have. If none, please write "NONE". *
By checking the box below, you are confirming you are the PARENT/GUARDIAN OF THE STUDENT NAMED ABOVE and agree 1) that the information provided above is true and accurate to the best of your knowledge, & 2) to have Hillside Arts and Letters Academy register, access academic records, and create a schedule for the student. *
Required
By checking the box below, you are confirming you are the STUDENT named above and agree that the information provided above is true and accurate to the best of your knowledge.
Media Consent: I hereby consent to my child participating in interviews, the use of quotes, and the taking of photographs, movies, or videotapes of the Student named above by Hillside Arts and Letters Academy. I also grant to the right to edit, use, and reuse said products for nonprofit purposes including use in print, on the internet, and all other forms of media. I also hereby release the New YorkCity Department of Education and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above. *
Required
Please fill this required Lunch form for your NYCDOE Student. https://www.myschoolapps.com/Home/PickDistrict *
Required
Which form of learning is your child registered for? *
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