Students Name
*
First Name
Last Name
Student ID #
*
Students Grade
*
Please Select
8
9
10
11
Students School
*
Please Select
Turtle Hook Middle School
Lawrence Road Middle School
Uniondale High School
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Information
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Cell Phone Number
*
Please enter a valid phone number.
House Phone Number
*
Please enter a valid phone number.
Parent/Guardian Email
*
example@example.com
Emergency Information
Emergency Contact's Name
*
First Name
Last Name
Relationship
*
Please Select
Parent
Sibling
Grandparent
Aunt/Uncle
Other
Relationship to Student
Parent/Guardian Cell Phone Number
*
Please enter a valid phone number.
Alt. phone Number
*
Please enter a valid phone number.
Does your child have any allergies or important medical conditions? If yes, please describe.
*
Submit
Should be Empty: