Yearbook University™ Student Registration
This form must be completed by each student attending Yearbook University™
Student Name
*
First Name
Last Name
Student Cell Phone Number
*
Format: (000) 000-0000.
Student eMail Address
*
example@example.com
School Name
*
Adviser Email
*
example@example.com
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Parent/Guardian Information
Parent/Guardian Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Phone Number
*
Format: (000) 000-0000.
Parent/Guardian eMail
*
example@example.com
Student Medical Information
Physician's Name
*
First Name
Last Name
Physician's Phone Number
*
Format: (000) 000-0000.
Medical Concerns
Please share with us if your minor has any medical concerns, such as allergies, dietary restrictions, or other information we should be aware of. Providing this information is completely voluntary and not required.
Health Insurance Provider Name
*
Insurance Policy Number
*
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Yearbook University™ Terms & Conditions
Parents, Guardians, & Students **Please Read Carefully**
Parent/Legal Guardian Signature
*
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