Middle School Student Registration (2018-19)

Middle School Student Registration for 2024-25
Student's Name*

First NameLast Name
Gender*

MF
Grade 2024-25*
Birth Date*

MonthDayYear
Date
Student's Cell # *
Student cell # only, don't put Parent Cell, if no cell put (000) 000-0000
Student's E-mail
Student Email Only, not parent email; example@example.com
Home Street Address*
Home City*
Home Zip Code*
Parent/Guardian Information
Dad or Guardian's Name

First NameLast Name
Dad or Guardian's Cell #
Dad or Guardian's E-mail
Mom or Guardian's Name

First NameLast Name
Mom or Guardian's Cell #
Mom or Guardian's E-mail
example@example.com
Emergency Information
Emergency Parent/Guardian Contact Name*

First NameLast Name
Relationship*
Emergency Parent/Guardian Contact Cell #*
Email Address of Parent/Guardian for Communication *
Parent/Guardian Email Only; example@example.com
School Name*
Upload a Front Copy of Student's Health Insurance Card (take pic with the card laying flat not in your hand with thumb/finger prints with no glares or shadows)*

Browse Files

Cancelof
Upload a Back Copy of Student's Health Insurance Card (take pic with the card laying flat not in your hand with thumb/finger prints with no glares or shadows)*

Browse Files

Cancelof
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe or state None!*
PLEASE NOTE:

You are providing a mobile # & email address for the student & parent for emergencies & agreeing to receive text messages from txt 180 & emails from Mailchimp. We will also need a Parent Consent Form for each event your student attends; possibly non-refundable deposits & a copy of their health insurance card front & back. Please visit http://sharonchurch.com/ministries/middle-school-grades-6-8/ for more information.
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Middle School Student Registration for 2024-25