2017-18 Academic Year Registration
Please fill out this Emergency Contact Form for the academic year. This form and information within it is valid from September 2017 through May 2018.
Student Information
Student(s) Name, Gender, & Date of Birth
Your answer
Current School(s)
Your answer
Ethnicity
Allergies (if any)
Your answer
Special health or behavioral notes (if any)
Your answer
Parent/Guardian Information
Name, Relationship to student(s)
Your answer
Home Address (Street, City, State, Zip Code)
Your answer
Phone Number
Your answer
Email
Your answer
Emergency Contact
Same as above
Different, contact below...
Name
Your answer
Phone Number
Your answer
Email Address
Your answer
Home Address (Street, City, State, Zip Code)
Your answer
Agreement
<INSERT LINK TO STUDENT CODE OF CONDUCT WORDING>
Required
Additional Notes/Comments/Concerns:
Your answer
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