Registration

Registration

Returning Students Only
Students Name:

First NameLast Name
Grade:
Contact Information:

Please complete the Home contact information below. If Mother and Father are separated complete contact information for both parents individually.
Home Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Home Email:
example@example.com
Mothers Individual Contact Information (only if parents are separated):

First NameLast Name
Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Fathers Individual Information (only needed if parents are separated):

First NameLast Name
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email
example@example.com
Do you need to update your emergency contact info from last year?*

Yes - If so please contact District Office at: 209-881-3382No
Do you need to update any health insurance information or new health concerns for your child for this school year?*

Yes - If so please contact District Office at 209-881-3382No
Parents Signature:*
Date

MonthDayYear
Date
Should be Empty: