Student Registration

Student Registration

2020-2021 School Year
Section 1:

Student Information
Student's Legal Name:

First Name Last Name
What name do you call this child at home?
Birth Date

Month Day Year
Date
Child's Address
Is your child allergic to any foods?

Yes No
If yes, what food(s)?
Does your child have any dietary restrictions?

Yes No
If yes, what restriction(s)?
Does your child have any medical conditions that require him/her to have specialized treatment?

Yes No
If yes, what condition(s)?
Is there any information that you would like your child's teacher to know?
Section 2:

Family Information
Parent or Legal Guardian 1

First Name Last Name
Email Address
Primary Phone Number

Area Code Phone Number
Secondary Phone Number

Area Code Phone Number
Parent or Legal Guardian 2

First Name Last Name
Email Address
Primary Phone Number

Area Code Phone Number
Secondary Phone Number

Area Code Phone Number

Who lives in the same house as the student?

Name

Relationship to Student

In addition to the Parents/Guardians, who is authorized to pick up your child from school?

Name

Phone Number

Section 3:

Videos or Photographs of your child may be taken during class. We will never publish or post a photo or video of your child without your written permission. Please let us know your preferences for your child's photos and videos.
Do you give permission for your child's photo/video to be posted on the school's Facebook page?

Yes No
Do you give permission for your child's photo/video to be posted on the school's website?

Yes No
Do you give permission for your child's photo/video to be used in advertisements for the school?

Yes No
Class Selection

Available Class times are subject to change based on enrollment.
Signature

Clear
Which Class would you prefer to have your child attend?
Today's Date

Month Day Year
Date
Should be Empty:

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Section 1: