2019-2020 Environmental Science, Psychology, Film as Literature, and Registration
2019/2020 High School Registration Form
Student's first name *
Your answer
Student's last name *
Your answer
Student's birthday *
MM
/
DD
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YYYY
Parent(s) first and last name(s) *
Your answer
Student's grade *
Mailing Address *
Your answer
Mother's phone number
Your answer
Email address
Your answer
Father's phone number
Your answer
Email address
Your answer
Home Address
Your answer
Enrollment
Space is limited. You will receive an email confirmation of your student's acceptance into class or placement on the wait list.

In the event that classes meet maximum enrollment your student will be placed on a waiting list.

Fees include the building use and most curriculum, student may be required to buy specific literature, or borrow from the library.
Enrollment: *
Required
Please read and check all the following boxes *
Required
Billing *
Which charter or correspondence program are you with
Who is your sponsor, contact, or advisory teacher?
Your answer
Media Release
I, the legal parent/guardian of the minor listed above, give Sandra McMahon permission to use audio/video footage and photographic images that include my student and/or my student's work. Media may be used for work samples, publications (such as Facebook, flyers, posters, website, slide shows, etc.) Student’s names will not be listed on any images other than work samples supplied to families and/or sponsor teachers.
*
Required
Special Concerns
Please list any medical or other needs that the instructor should be aware of. (allergies, asthma, learning challenges, etc.)
Your answer
Emergency Contact
Please list a name and phone number of someone other than a parent that we can contact in the event of an emergency in which we cannot reach you.
First and Last name and phone number *
Your answer
Permission *
Release of Liability *
The information provided in this form is true and accurate. I agree to the permission and release of liability above. Please sign by typing your full name: *
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