Student's Full Name *

First Name

Last Name

Child's Birthdate *

MM

DD

YYYY

Guardian 1 Full Name *

Parent 1 or Guardian 1 Full Name

First Name

Last Name

Guardian 1 Cell Phone *

(###)

###

####

Guardian 1 Home Address *

You must enter your address even if it is the same as your child's permanent address.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Guardian 1 Work Address *

if you work from home please state that. If you do not work, please answer with N/A

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Guardian 1 Work Phone *

(###)

###

####

I would like to enroll in text alerts for emergency purposes *

If you choose yes, standard text messaging rates may apply.

Yes

No

Guardian 2 Full Name *

First Name

Last Name

Guardian 2 Home Phone *

(###)

###

####

Guardian 2 Cell Phone *

(###)

###

####

Guardian 2 Home Address *

If the address is the same as Guardian 1, please write Same as Guardian 1.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Guardian 2 Employee Address *

If you do not work please write N/A

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Guardian 2 Employee Phone *

(###)

###

####

I would like to enroll in text alerts for emergency purposes. *

If you are a single-parent household please select no for this option.

Yes

No

Emergency Contact 1 *

Please list the full name of the emergency contact

First Name

Last Name

Home Phone *

This is for emergency contact 1

(###)

###

####

Cell Phone *

This is for emergency contact 1

(###)

###

####

Address for Emergency Contact 1 *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact 2 *

This must be a different person than emergency contact 1. This is required by law and for the safety of your child.

First Name

Last Name

Home Phone *

This is for emergency contact 2

(###)

###

####

Cell Phone *

This is for emergency contact 2

(###)

###

####

Address for Emergency Contact 2 *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact 3 *

Please provide the full name for emergency contact 3. this must be someone different than emergency contact 1 or 2.

First Name

Last Name

Home Phone *

This is for emergency contact 3

(###)

###

####

Cell Phone *

This is for emergency contact 3

(###)

###

####

Address for Emergency Contact 3 *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country