Rocket Academy Enrollment Agreement
Please read pages 1 & 2, answer all questions that follow, then add Parent & Student e-signatures to show agreement.
Page 1
Page 2
Course Requested *
Student Name *
Student Birthdate *
MM
/
DD
/
YYYY
Student Grade *
Student email *
Student E-Signature *
Parent Name *
Parent Phone Number *
Parent Email Address *REQUIRED* *
Parent/Student Street Address, City, and Zip Code *
Parent E-Signature *
Submit
Never submit passwords through Google Forms.
This form was created inside of Berne Union Local Schools.