Albion School Registration

Phone Number
Please enter a valid phone number.
Employer
Name

First and Last NameRelationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Employer
Is custody of this child decreed by the courths?

yesNo
If yes who has custody?
Relationship?
Emergency Contact 1
Name

First NameLast Name
Phone Number

Area CodePhone Number
Emergency Contact 2
Name

First NameLast Name
Phone Number

Area CodePhone Number
Persons NOT allowed to pick up child
Persons allowed to pick up child
Physician and Medical Information
Name

First NameLast Name
Phone Number

Area CodePhone Number
Preferred Hospital
Insurance/Health Coverage (Company)
Sooner Care/Medicaid #
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.
I give permission for a school administrator/designated employee to administer non-prescription, symptomatic medications.

yesno
I give permission for Albion Public School to sign for emergency medical treatment for my child in the event that I cannot be reached. All attempts will be made to contact me first.

yesno

School Registration 2021-2022