Community Education Registration 2018-19-(This form used for Driver's Education registration only. 2019-20 registration will be available soon.)
Student’s Name *
Please type in First Name and Last Name (Jane Doe)
Your answer
Gender *
Age *
Your answer
School Attending
Your answer
Grade (2018-19) *
Your answer
Teacher (2018-19) *
Your answer
Is student attending After School Program? *
Required
Email *
If more than one email, separate with a comma.
Your answer
Mailing Address *
Number and Street Name
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
911 Address *
Your answer
Mother's Name *
First and Last Name
Your answer
Mother's Employer *
Your answer
Mother's Residence Phone *
Your answer
Mother's Cell Phone *
Your answer
Mother's Business Phone
Your answer
Father's Name *
First and Last Name
Your answer
Father's Employer *
Your answer
Father's Residence Phone *
Your answer
Father's Cell Phone *
Your answer
Father's Business Phone
Your answer
Names of other family members enrolled in Community Education classes
First and Last Name(s)
Your answer
Health Comments
Your answer
Physician's Name *
Your answer
Physician's Phone Number *
Your answer
Insurance Company Name *
Your answer
Policy Number *
Your answer
Approved person to pick up student #1 *
List name of APPROVED (in addition to parents listed above) person to pick up student. (INCLUDE PHONE NUMBER) Name, Phone
Your answer
Approved person to pick up student #2 *
List name of APPROVED (in addition to parents listed above) person to pick up student. (INCLUDE PHONE NUMBER) Name, Phone
Your answer
Approved person to pick up student #3 *
List name of APPROVED (in addition to parents listed above) person to pick up student. (INCLUDE PHONE NUMBER) Name, Phone
Your answer
The following people are NOT APPROVED to pick up student: (May require legal documentation)
Your answer
By checking the box below, I agree that student has permission to participate in the Before and/or After School Program and photos of him/her may be used on Bryan County Schools social media pages for educational purposes only. *
Required
Course #1 Title and Cost
Your answer
Course #2 Title and Cost
Your answer
Custodial Parent/Guardian Signature *
Type your name as digital signature
Your answer
Submit
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