Hamilton County Virtual School Registration Form
East Hamilton School
Email address *
STUDENT INFORMATION SECTION:
Student's Last Name: *
Student's First Name: *
Student's Grade: *
Student's Birthdate: *
Student's Email Address: *
Student's Home Phone Number: *
Student's Cell Phone Number: *
Student's Address (please include city, state, and zip code): *
PARENT INFORMATION SECTION:
Parent's Last Name: *
Parent's First Name: *
Parent's Email Address: *
Parent's Home Phone Number: *
Parent's Cell Phone Number: *
COURSE INFORMATION SECTION:
Course #1 Name: *
Course #2 Name: *
SIGNATURES:
Student Signature: *
Parent Signature: *
Today's Date: *
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A copy of your responses will be emailed to the address you provided.
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