SUNDAY: Farm Days
Winter 2021
Class Date
Sun (3/21)
Sun (3/28)
Sun (4/04)
Sun (4/11)
Sun (4/18)
Student's Information
Last Name
*
First Name
*
Middle Name
*
Gender
*
Male
Female
Other
Address
*
City
*
State
*
Zip
*
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Grade entering in the fall
*
Please Select
Senior
Junior
Sophomore
Freshmen
8th
7th
Unisex shirt size
Small
Medium
Large
XLarge
Parent or Legal Guardian Information
Parent/Legal Guardian
*
Relation
*
Work Phone
*
-
Area Code
Phone Number
Cell Phone
-
Area Code
Phone Number
Parent /Legal Guardian 2
*
Relation 2
*
Work Phone 2
*
-
Area Code
Phone Number
Cell Phone 2
-
Area Code
Phone Number
Home Phone
*
-
Area Code
Phone Number
Emergency Contact Info
Emergency Contact Name(if parent or guardian is not avaliable)
*
Emergency Number
*
-
Area Code
Phone Number
Emergency Number #2
*
-
Area Code
Phone Number
Email Confirmation
Parents Email (students confirmation will be sent by email, if left blank it will be mailed)
Student's Email
Health Information
Are immunications up to date?
Yes
No
Date of last tetanus shot
Any activity the student should be restricted from?
Any physical, mental or other condition that would require special attention or medication while in class?
List all medications, both prescribed and over the counter, all medications will be turned into the health officer except rescue inhalers, bring all medication in original containers.
List any allergies (ex: bees,peanuts, dairy)
Any dietary needs that we should know about?
Student Photo Release
I agree that photos of my child can be taken and used for social media purposes
Yes
No
Be
certain to enter your email address
correctly on the registration form to receive confirmation via email with in 2 weeks
Electronic signature, please initials
*
Date
-
Month
-
Day
Year
Date
Name
First Name
Last Name
Submit
Should be Empty: