On-Site E-Learning Registration
Thank you so much for your interest in the Stone CDC On-Site E-Learning Center! Please complete the registration form as accurately as possible. Please note that our On-site E-learning Center is for students in grades K-6 and will operate from 9 AM-2:30 PM.
First Name *
Last Name *
Street Address *
City *
State *
Zip *
Phone *
Email *
Please list your child's name, grade, school (Ex. John Mitchell, 6th, Disney School) If you have multiple children, please enter additional children separately in the next question. *
Additional Children: Please list your child's name, grade, school (Ex. John Mitchell, 6th, Disney School)
Child(ren) Birthdate's (Format: xx/xx/xxxx) *
What challenges are you experiencing with e-learning? *
Required
Please select the choice that describes your child's reading skills. *
Required
Please select the choice that best describes your child's math skills. *
Required
Please provide your child(ren)'s school':s e-learning time schedule. List their lunchtime. Ex. 8:30A-2:30P, Lunch 11:00AM) *
Emergency Contact (Name/Relationship). *
Emergency Contact Phone *
Specify any food allergies, medications, instructions, etc. If not applicable, please type "N/A" *
Any additional questions/concerns/comments:
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy