ITEC Parent Permission Form
Please fill out the form below to complete registration for ITEC classes. All information entered in the fields below is for internal use only and will not be shared with other organizations. Please complete one form per student per class.
* Required
Parent First Name
*
Your answer
Parent Last Name
*
Your answer
Street Address
*
Your answer
City
*
Your answer
ZIP Code
*
Your answer
Email Address
*
Your answer
Phone Number
*
Your answer
Student First Name
*
Your answer
Student Last Name
*
Your answer
Student Grade (Fall 2019)
*
Choose
4th
5th
6th
7th
8th
9th
10th
11th
12th
Student Age (As of June 2019)
*
Choose
9
10
11
12
13
14
15
16
17
18
Student Gender
*
Female
Male
Other:
Student Allergies?
*
Your answer
How did you hear about us?
*
Your answer
Please list the names of any other adults who are authorized to pick up your child.
Your answer
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